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CENTRE FOR SOCIAL SCIENCE RESEARCH Adapting South Africa’s Social Protection System for COVID-19 Sydney Johnson Remy Reya Julia Ilhardt CSSR Working Paper No. 451 April 28, 2020
CENTRE FOR
SOCIAL SCIENCE RESEARCH
Adapting South Africa’s Social Protection System for COVID-19
Sydney Johnson
Remy Reya
Julia Ilhardt
CSSR Working Paper No. 451
April 28, 2020
Published by the Centre for Social Science Research
University of Cape Town
2020
http://www.cssr.uct.ac.za
This Working Paper can be downloaded from:
http://cssr.uct.ac.za/pub/wp/451
ISBN: 978-1-77011-438-8
© Centre for Social Science Research, UCT, 2020
About the authors:
The authors are undergraduate students at Princeton University, who spent the first part of 2020 as study abroad students at the University of Cape Town. This paper comprises a report written as part of the requirements of the Study Abroad programme of the Woodrow Wilson School of Public and International Affairs at Princeton.
Executive Summary: Adapting South Africa’s Social Protection System for COVID-19
This report considers proposals for adapting South Africa’s social protection system in response to
COVID-19, specifically aimed at assisting three vulnerable populations: the very poor, the informally
employed, and the immunocompromised poor. The following are key points and proposed
interventions from each of the report’s three chapters:
The very poor:
● Recent data suggest that around 13.7 million South Africans live in extreme poverty, earning
less than R561 per month. 6.4 million of those living below the Food Poverty Line (FPL) are
children.
● Living conditions for South Africa’s very poor are conducive to viral spread and make strict
adherence to lockdown regulations potentially dangerous, as families don’t have enough
money or stockpiled food to support themselves for an extended period of time.
● Providing Social Relief of Distress (SRD) as a temporary means-tested basic income for the
very poor would allow the government to support a vulnerable population through one
program.
● Alternatively, providing SRD for single adults under the FPL and topping up the CSG for
families under the FPL would allow the government to capitalize on a preexisting network of
support.
The informally employed:
● In South Africa, roughly 30% of employment is informal, representing 5 million workers. An
estimated 70% of these workers are waged employees, likely to lose incomes as a result of the
COVID-19 lockdown and generally ineligible for Unemployment Insurance Fund (UIF)
benefits
● The UIF would ideally be expanded to newly unemployed informal laborers via a targeted
grant, but considering the administrative constraints on registering workers, the UIF could
instead be extended to all poor, working-age South Africans who do not benefit from other
social grants
● Alternatively, the Child Support Grant (CSG) could be supplemented as a proxy for
benefiting informal laborers. Amongst the poorest half of South Africans, 80% of households
including an informal worker are households in which someone receives the CSG
The immunocompromised poor:
● There is a large immunocompromised population in South Africa due to dual HIV and TB
epidemics, and these illnesses disproportionately affect low-income individuals
● Immunocompromised persons are considered high-risk for developing complications from
COVID-19 infection and are urged to take additional health precautions
● To enable this group to take extra precautions, grant access should be extended to those who
are not covered through a Chronic Illness Grant (CIG) or expansion of the Disability Grant
(DG)
● As lockdown restrictions begin to ease in the following weeks, policymakers should keep in
mind the vulnerabilities of the immunocompromised poor and the public health risk of
incapacitating an already overburdened health system by failing to protect this population
from severe illness
Conclusion
● President Ramaphosa’s plan for modifying South Africa’s social protection framework to
respond to COVID-19 has many strengths, but the details of implementation on a community
level must be clarified in order for the strategy to holistically support the country’s most
vulnerable populations.
2
Introduction
Overview of Report
In late January and early February 2020, thousands of university-age students from
over 100 countries flew to South Africa to experience International Students Orientation at
the University of Cape Town (UCT). The majority of these students would be enrolled at
UCT for the next several years of their education, pursuing degrees in commerce,
engineering, health sciences, law, science, and the humanities. But a large subset — including
the authors of this report — were temporary visitors, spending five months participating in
the academic and extracurricular life of the university through the Semester Study Abroad
(SSA) program.
Before coming to Cape Town, we were all studying public policy at the Princeton
University campus in New Jersey. During the third year of our undergraduate degree from
Princeton’s Woodrow Wilson School of Public and International Affairs, we were all
required to enroll in a semester-long policy task force examining some social or political
issue through a policy lens. Princeton offers a number of on-campus courses to complete this
requirement and partners with professors at international universities abroad to offer two task
forces abroad each semester. When we arrived in South Africa, the three of us were placed
under the supervision of Professor Jeremy Seekings, the Director of the Centre for Social
Science Research at UCT. We would be studying social protection programs in South Africa
and crafting some sort of policy proposal pertaining to the vast network of social grants that
supports around 18 million people in the country.1
1 Full BR
3
In our first few weekly meetings, we convened in the Leslie Social Sciences building
at UCT to discuss the changing scope of South Africa’s welfare regime, the political question
of affordability, and community- and household-level effects of social grants. We weighed
the possibility of female empowerment against the chance of intergenerational conflict in
considering the merits of the Child Support Grant; we grappled with the notion of
dependency in the administration of the Disability Grant. For about four weeks, these
conversations continued largely uninterrupted. Then COVID-19 swept in.
The novel coronavirus, or SARS-CoV-2, was first detected in December 2019, when
a cluster of cases were detected in the Hubei province of China. Throughout January and
even February, the virus was just a story about China; even when individual cases started to
pop up elsewhere, complacency reigned. By early March, the virus had spread to all regions
of Italy, which would turn out to be one of the hardest-hit countries in Europe. The virus
came up in our March 3 task force meeting as we began to learn from conversations with our
families of a quickly-shifting social and political atmosphere in the U.S. — though it still
seemed distant at the time. South Africa’s first case was detected on March 5, and yet
dubious narratives about the country’s ostensible imperviousness to outbreak due to a warm
climate and sparse travel from heavily-affected regions still pervaded the national dialogue.
Unbeknownst to us, our March 10 conference would be our last in-person meeting. In
the following week, South African President Cyril Ramaphosa declared a national state of
disaster, announcing travel restrictions and school closures in anticipation of an outbreak. Our
school’s study abroad program was cancelled, and by the time the president announced a
national lockdown, the three of us had flown back to the U.S. and entered into the two-week
quarantine recommended for international travelers.
In an email in late March, Professor Seekings suggested we write a policy paper about
how the social grants we’d been studying for the past month might be adjusted in response to
4
the pandemic. At the time, the question seemed largely theoretical; but as we kept up with
news reports about the country we had just evacuated, soon unrecognizable due to lockdown
restrictions, it became increasingly clear that the social protection system in South Africa was
about to undergo an unprecedented stress test. From our homes in San Diego, Chicago, and
Washington, D.C., we began to research and write. The situation on the ground in South
Africa was changing daily; the government even proposed a set of reforms to its social
protection system, which forced us to reshape the scope of our report. But in just over a
month, through Zoom meetings and a distressingly-long email thread, we managed to
construct a composite report evaluating the capacity of South Africa’s social grants to address
the unique needs of acutely at-risk populations during a national lockdown and a global
pandemic.
The result, in the pages that follow, is a highly topical policy paper about a country
that was consistently six to nine hours ahead of us. It is limited in scope and reliant on data
that may soon be proven irrelevant by South Africa’s ever-shifting policy landscape — but it
also offers the beginnings of answers to fundamental questions about how a severely unequal
country can best support its most vulnerable. All it took to get there was an encouraging
adviser and a bit of self-isolation.
COVID-19 in South Africa
In anticipation of widespread effects of the COVID-19 outbreak in the country, South
African President Cyril Ramaphosa declared a State of National Disaster on March 15, 2020.
Ramaphosa proclaimed that only essential personnel were exempted from the strict stay-at-
home orders and only essential businesses were allowed to remain open. Ramaphosa
recognized that this lockdown would have “a considerable impact on people’s livelihoods, on
the life of our society and on our economy,” but concluded that “the human cost of delaying
5
this action would be far, far greater.”2 In light of the decision to impose a lockdown, the
South African Social Security Agency (SASSA) made some grant payments available earlier
than usual for April of 2020.3 This move was made with particular regard for two groups of
vulnerable grant recipients — elderly and disabled South Africans — who would be able to
collect the Old Age Pension and the Disability Grant payments, respectively, on the last two
days of March. The government’s hope was that this decision would ease the possibility of
overcrowding at pay stations throughout the country during a time when social distancing
was being encouraged.4
As evidence of the devastation that the spread of COVID-19 caused within other
countries mounted, the President addressed the South African people again on April 9 with
the news that the lockdown would be extended “by a further two weeks beyond the initial 21
days.”5 At time of writing, South Africa has the most COVID-19 cases of any African
country.6 South Africa has conducted 178,000 tests, with 4,793 positive cases and 87 deaths.7
Why South Africa is Different
South Africa is already equipped with a considerably robust social protection system.
By 2014, approximately one in three South Africans received some form of social grant. In a
chapter on South Africa’s welfare state, Seekings and Nattrass write that the country’s social
assistance programs are “without peer in terms of expenditures (in relation to GDP) among
2 “Statement by President Cyril Ramaphosa on Escalation of Measures to Combat the Covid-19 Epidemic,
Union Buildings, Tshwane | The Presidency,” accessed April 23, 2020, /speeches/statement-president-cyril-
ramaphosa-escalation-measures-combat-covid-19-epidemic%2C-union. 3 Mokhoali, “Early Pension Payments as Sassa Seeks to Keep Elderly Safe from COVID-19.” 4 South African Government News Agency, “SASSA Pays April 2020 Grants Earlier amid Covid19.” 5 “President Cyril Ramaphosa: Extension of Coronavirus COVID-19 Lockdown to the End of April | South
African Government,” accessed April 23, 2020, https://www.gov.za/speeches/president-cyril-ramaphosa-
extension-coronavirus-covid-19-lockdown-end-april-9-apr-2020-0000. 6 Abdur Rahman and Alfa Shaban, “Coronavirus across Africa: 25,940 Cases; 1,240 Deaths; 6,968 Recoveries,”
Africanews, April 23, 2020, https://www.africanews.com/2020/04/23/coronavirus-in-africa-breakdown-of-
infected-virus-free-countries/. 7 “COVID-19 South African Coronavirus News and Information,” SA Coronavirus Online Portal, n.d.,
coronavirus.co.za.
6
major developing economies or in terms of coverage (in relation to the population) anywhere
at any time.”8 Thus, South Africa’s social protection system reaches a broad swath of
vulnerable residents and may provide a useful, though incomplete, basis for constructing a
response to COVID-19.
Additionally, South Africa is uniquely positioned to confront the COVID-19
pandemic. For decades, research and funding has been dedicated to combating tuberculosis
(TB) and HIV prevalence among the general population. The country currently has the largest
HIV epidemic and the sixth largest TB epidemic in the world, with an approximated 60% of
people living with HIV (PLHIV) also infected with TB. In response to this, South Africa has
developed the world’s largest antiretroviral (ARV) treatment program to fight HIV, so,
understandably, the nation’s current COVID-19 interventions are informed by the history of
its battles with HIV and TB.9 HIV researchers are using technologies established to help
understand individuals’ immune responses to HIV to better understand the differences
between “good” and “bad” immune responses within people infected with COVID-19.10
Additionally, the National Health Laboratory Service (NHLS) reports that over 180
GeneXpert machines, typically used for TB testing, are being repurposed for COVID-19
testing. The machines are small enough to be transported in mobile labs so that testing can
take place in South Africa’s most high-risk communities, and they can deliver results in 45
minutes.11
8 Jeremy Seekings and Nicoli Nattrass, “Income Support Through the Welfare State,” in Policy, Politics and
Poverty in South Africa, Developmental Pathways to Poverty Reduction Series (London: Palgrave Macmillan
UK, 2015), 133–61, https://doi.org/10.1057/9781137452696_6. 9 “HIV and AIDS in South Africa,” Avert, July 21, 2015, https://www.avert.org/professionals/hiv-around-
world/sub-saharan-africa/south-africa. 10 Sarah Wild, “South Africa’s Leadership in HIV Research Is Galvanizing to Tackle Coronavirus and Develop
Tests,” Quartz Africa, accessed April 13, 2020, https://qz.com/africa/1831067/south-africas-hiv-researchers-are-
turning-on-coronavirus/. 11 “NHLS’ Preparedness for Testing to Meet COVID-19 Demands,” National Health Laboratory Service (blog),
accessed April 14, 2020, https://www.nhls.ac.za/nhls-preparedness-for-testing-to-meet-covid-19-demands/.
7
South Africa also differs from other nations in terms of the capacity of its health
services. The doctor-patient ratio in South Africa sits at 0.9, and 84% of the population uses
an inefficient public health system due to a lack of medical insurance. Consequently, a large
portion of South Africans rely upon facilities with improper infection control and limited
drug availability for their health care.12 Due to the dual epidemics of HIV and TB, South
Africa cannot afford to have COVID-19 spread rapidly amongst its large
immunocompromised populations lest medical facilities become overwhelmed with severely
ill COVID-19 patients.
However, the scale of the pandemic in South Africa has proven to be much different
than it is in other nations. As of April 27, there have been over 205,000 deaths worldwide, yet
South Africa has only seen 87.13 It is likely that the government’s haste to declare a State of
National Disaster and subsequent implementation of a nationwide lockdown have saved
thousands of lives. South Africa has not experienced the public health devastation that other
nations, such as the United States and Italy (with over 54,000 and 26,000 deaths,
respectively), have experienced. Rather, what threatens South Africa are the looming
economic consequences of long-term, stringent stay-at-home orders.
12 Mike Cohen, “Analysis | How South Africa Plans to Fix an Ailing Health System,” Washington Post,
accessed April 8, 2020, https://www.washingtonpost.com/business/how-south-africa-plans-to-fix-an-ailing-
health-system/2019/08/14/7a8b0fae-be6a-11e9-a8b0-7ed8a0d5dc5d_story.html. 13 Max Roser et al., “Coronavirus Pandemic (COVID-19),” Our World in Data, March 4, 2020,
https://ourworldindata.org/coronavirus.
8
Source: Our World in Data, 2020.
International Responses to COVID-19
As of April 24, 151 countries had “planned or ongoing social protection measures in
response to COVID-19,” tracked in the “living paper” by Gentilini et al. on its sixth iteration
at time of writing. 60% of global social protection interventions take the form of social
assistance, including 222 cash-based programs and 89 in-kind programs. In particular, new or
adapted cash transfers are now estimated to benefit 1.36 billion people, including via
expanded coverage as in El Salvador and the Philippines, increased benefits as in Egypt, and
simplified administrative requirements as in Malaysia and Algeria. As for in-kind transfers,
the majority of programs center around access to food or resource vouchers. Several countries
have created measures focused on provisioning food to the 368 million children who
previously benefited from school meals. Gentilini et al. explain that feeding programs
frequently include home food delivery, as with Guatemala’s system organized by “parent
associations” and Jamaica’s program organized by the private sector.
Another 26% of global social protection schemes are social insurance programs, with
179 measures including “paid sick support,” “unemployment benefit,” and “social security
contribution waiver/subsidy.” Finally, countries around the world have created 93 labor
9
market interventions, primarily wage subsidies as in Kosovo and Thailand. In Africa,
COVID-19 responses have primarily depended on social assistance programs, with 30
countries implementing 68 measures across the continent. At least 15 African countries have
not announced social protection measures in response to COVID-19.
President Ramaphosa’s Reform Proposals
On April 21st, 2020, South African President Cyril Ramaphosa announced a new plan
to address the economic consequences of COVID-19, estimated to cost 500 billion rand or
about 10% of GDP. This package of reforms is meant to “address the extreme decline in
supply and demand and protect jobs.”14 This plan includes a number of alterations to South
Africa’s social protection system analyzed over the course of this report, including
supplementation of the CSG and a new COVID-19 Social Relief of Distress Grant. The
proposals in the following chapters were written prior to the announcement of Ramaphosa’s
stimulus plan, and the potential effectiveness or shortcomings of the governmental response
to COVID-19 will be considered in the conclusion of this report.
Population Focuses
This report focuses specifically on interventions for three populations: the very poor,
the informally employed, and the immunocompromised poor. While there are many other
populations that are at risk both physically and financially during this period, these groups
have been identified as some of the most acutely vulnerable in South Africa — especially in
light of their potential for exclusion from the vast social protection framework. Beyond
financial constraints, the very poor live in areas with potentially high transmissibility; many
14 “STATEMENT BY PRESIDENT CYRIL RAMAPHOSA ON FURTHER ECONOMIC AND SOCIAL
MEASURES IN RESPONSE THE COVID-19 EPIDEMIC,” SA Coronavirus Online Portal, April 21, 2020,
https://sacoronavirus.co.za/2020/04/21/extraordinary-budget-for-coronavirus-response/.
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informal laborers are no longer making an income; and the immunocompromised are at
heightened risk for severe illness.
The three sections of this paper will consider the ramifications of various strategies
for supporting the aforementioned populations (in order of decreasing scope) through social
grant modifications and expansions: Social Relief of Distress for the very poor (Chapter 1);
the Unemployment Insurance Fund for the informally employed (Chapter 2); and the
Disability Grant for the immunocompromised poor (Chapter 3). The Child Support Grant —
reaching approximately 7 million caregivers per month — will be considered as a proxy for
benefiting both the very poor and the informally employed.15 In the conclusion, we will make
note of international approaches to social protection during the COVID-19 pandemic and
address the plausibility of a UBI, which remains administratively complicated in South
Africa. We will also present a visual comparison of the various proposals addressed in the
report as a whole. Finally, we will offer specific commentary on the reforms to South
Africa’s social protection scheme announced by President Ramaphosa on April 21, 2020.
15 “Child Support Grant (CSG),” socialprotection.org, n.d., https://www.socialprotection.org/programme/child-
support-grant-csg.
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Chapter 1: The Very Poor
Remy Reya
Abstract
South Africa is not alone in its systematic response to the 2020 SARS-CoV-2 — the national
lockdown announced by President Cyril Ramaphosa on April 23, 2020 reflects stringent
measures taken to curb the spread of the virus around the world. But South Africa differs from
many countries in a key respect: its unparalleled levels of inequality. Over half of the country’s
population lives in poverty, and more than 18 million are served by the country’s social grants
system.16
17 This paper examines the unique challenges faced by the 13.7 million South
Africans living in extreme poverty. Through modifications to current government policies
regarding social grants and adjustments to two of South Africa’s preexisting social protection
programs, I outline a set of proposals to ensure broad and adequate coverage for those most in
need. In particular, I recommend expansions to Social Relief of Distress and the Child Support
Grant that would likely see broad political support. The chapter concludes with a cost analysis
and a reminder that even in the face of a paradigm-shifting pandemic, we must not lose hold
of our ongoing battles for equal access and dignified living for all.
16 Gous, “SA Most Unequal Country in World.” 17 South African Government News Agency, “Social Grants Increased.”
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Introduction
South Africans in extreme poverty are at especially high risk during the pandemic.
Many of them live in townships where population density, communal toilets, and informal
housing make social distancing near-impossible; even as the threat of a rapidly-spreading
outbreak looms, the poorest South Africans don’t have the resources to support themselves
sustainably during a lockdown. Beyond the dearth of sanitation supplies, a general lack of
financial means and distance from shops exacerbate the desperation for individuals and
families on the bottom end of the socioeconomic ladder in the most unequal country on
earth.18
Huge job losses have been predicted for the coming months, with estimates ranging
from 370,000 to over one million — and these figures don’t even account for work disruption
in the informal sector, which is thought to employ around 3 million South Africans.19 20
21
Compounding the risk for hunger brought on by unemployment is the shutdown of a wide
network of feeding schemes; in the wake of school closures, the 9.6 million South African
children who generally rely on school feeding programs are left without a daily meal. Many
adults who found sustenance through community-based programs are in similar
predicaments.22
Of course, as the food supply chain has been disrupted, prices have risen: a project
monitoring food prices noted a 7% (R220) increase in the cost of a food basket for a low-
income family in the month of March alone, coupled with a shift toward a less nutritious diet
for these families.23 Given that this effect is only expected to worsen in coming months as a
18 Trenchard, “PHOTOS: Lockdown in the World’s Most Unequal Country.” 19 South African Reserve Bank, “Monetary Policy Review, April 2020.” 20 Omarjee, “SA Business Alliance Expects 1 Million Job Losses, Economy to Contract by 10%.” 21 Stats SA, “Quarterly Labor Force Survey,” 1. 22 Holmes, “The Scramble to Feed South Africa’s Neediest During Lockdown.” 23 Mathews et al., “Ramaphosa, Please Increase the Child Support Grant for the next 6 Months.”
13
result of “disruptions in farming and food supply chains resulting from the lockdown
procedures,”24 it is clear that the nutritional need for poor households must be systematically
addressed.
In this chapter, I will present several potential means of supporting the needs of the
very poor population in South Africa during the 2020 SARS-CoV-2 outbreak and national
lockdown. I will begin by constructing a reference figure for the number of people in extreme
poverty in South Africa. I will then introduce Social Relief of Distress and the Child Support
Grant as possible mechanisms for meaningful social intervention during a time of acute
vulnerability. I will continue by suggesting several general reforms — including a cash-based
SRD, remote application and renewal technologies, and governmental investment in local and
regional feeding schemes — before examining the practical and political ramifications of two
proposals for major reforms to the SRD and CSG programs. The chapter will conclude with a
cost analysis of the two proposals.
Estimating the Size of the Very Poor Population
South Africa has a population of around 58.8 million and measures poverty using
three official thresholds: the Food Poverty Line (FPL), which is meant to indicate the amount
of money an individual would need so as to afford the minimum required daily caloric intake;
the Lower-Bound Poverty Line (LBPL), which is calculated by adding the FPL value to the
the average expenditure on non-food items in households whose total expenditure is equal to
the FPL; and the Upper-Bound Poverty Line (UBPL), which is calculated by adding the FPL
value to the the average expenditure on non-food items in households whose food
expenditure is equal to the FPL.25 As of 2019, the FPL sat at R561 per person per month
24 Jonah, May, and Sambu, “Lockdowns Threaten Childrens’ Nutrition.” 25 Statistics SA, “SA Population Reaches 58,8 Million.”
14
(pppm), the LBPL sat at R810 pppm, and the UBPL sat at R1227 pppm.26 According to
Statistics South Africa, the FPL is often referred to as the “extreme” poverty line;27 South
Africans who fall below this line are likely to need urgent financial support throughout the
year, and especially during a pandemic.
According to snapshots provided by the Income and Expenditure Survey and the
Living Conditions Survey, the proportion of South Africans living below the FPL fluctuated
between 21.4% and 33.5% at various points between 2006 and 2015. Cross-referencing these
percentages with mid-year population estimates from StatsSA shows that between 10.8
million and 16.5 million people have lived in extreme poverty in any given year during the
data collection period. These data points average out to around 13.7 million people living
under the FPL, which lines up with other projections: a 2014 Oxfam report estimated that
one in four of the 54 million South Africans at the time (about 13.5 million people) struggled
with hunger regularly;28 and data on complex food access from the General Household
Survey show that around 24.7% of individuals (just under 14 million people) had to modify
their diet or eating patterns within the last month because of limited food sources in 2017.29
As for demography, rates of reported food insecurity were almost always directly
proportional to household size (households with more children were more frequently food-
insecure).30 Of the roughly 4.6 million households with young children (defined as five years
old or younger) in 2017, those led by females were notably more likely to experience hunger
(17.0%) than those led by men (9.4%).31 Findings from the 2014/15 Living Conditions
Survey corroborate these findings: households headed by females were more likely than
male-headed households to fall under the FPL (by 9.5 percentage points), the LBPL (by 14.2
26 Statistics SA, “National Poverty Lines, 2019,” 3. 27 Ibid, 3. 28 Teka Tsegay, Rusare, and Mistry, “Hidden Hunger in South Africa.” 29 Statistics SA, “General Household Survey, 2018,” 66. 30 Statistics SA, “Towards Measuring the Extent of Food Security in South Africa,” 17. 31 Statistics SA, “Towards Measuring the Extent of Food Security in South Africa,” 21.
15
percentage points), and the UBPL (by 16 percentage points).32 Data from between 2006 and
2015 also shows that the 0-17 age group has consistently seen higher rates of poverty than
any other age group.33
Social Relief of Distress and the Child Support Grant
On March 30, three elderly South Africans died in the vicinity of payment centers in
different provinces and in the process of collecting their grant money early through lockdown
accommodations made by the government. Though the deaths were not linked to the
government’s new policy and were generally thought to be faultless (two women collapsed
while walking and one man died on his way home), President Ramaphosa expressed
condolences to the families and indicated that SASSA would assist the victims’ families
through the Social Relief of Distress (SRD) program.34
Around this time, conversations among academics and government officials about
how to modify South Africa’s vast social protection scheme amidst the COVID-19 crisis and
associated national lockdown were beginning to ramp up. On April 8, SASSA announced that
it would provide support through SRD to grant beneficiaries whose grants expired in March
and who were unable to apply for renewal because of the shutdown of SASSA offices during
the nationwide lockdown, with preference given to individuals with no other source of
support.35 On April 14, finance minister Tito Mboweni confirmed that the government was
looking into increasing the Child Support Grant (CSG) and the Old-Age Pension (OAP), two
of the country’s largest grants programs. In an April 15 letter, a group of academics and civil
society leaders called on the South African government to take sweeping action to protect
vulnerable populations during the lockdown. Among other suggestions, they recommended
32 Statistics SA, “Poverty Trends in South Africa,” 79. 33 Statistics SA, “Poverty Trends in South Africa,” 59 34 Seleka, “Lockdown.” 35 South African Government News Agency, “SASSA Provides Food Parcel Relief.”
16
increasing the amount distributed via the CSG while providing SRD access to “vulnerable
households not already receiving grants.”36
In the short duration of this national dialogue, investments in the CSG and SRD have
been consistently cited as potentially lifesaving for the very poor.
Social Relief of Distress
The SRD program is South Africa’s emergency relief fund for individuals. It was first
introduced in 1991 through Fund-raising Amendment Act 115, in which it was defined as
“the alleviation of the need of persons by means of the temporary rendering of material
assistance to them[.]”37 In the following years, the political and economic landscape of South
Africa would shift significantly under the post-Apartheid government. In June 2004, just a
week after the South African Social Security Administration (SASSA) was established,38 the
2004 Social Assistance Act designated the Minister of Social Development as the arbiter in
decisions about social relief of distress.39
In 2020, SRD is normally distributed as food vouchers that can be redeemed at local
stores, food parcels intended for direct consumption, school uniforms, or simple cash.40 In
2009, in response to reports that a Western Cape NGO had been misinforming people of their
eligibility to receive the grant, Social Development Minister Zola Skweyiya clarified that
SRD was “meant to assist the poorest of the poor and the most vulnerable households.”41 As
such, citizens, permanent residents, and refugees hoping to receive support through SRD
must meet one or more of the following qualifications, outlined on SASSA’s website:
36 Mathews et al., “Ramaphosa, Please Increase the Child Support Grant for the next 6 Months.” 37 Fund-raising Amendment Act 115 of 1991 38 South African Social Security Agency Act, 2004 39 Social Assistance Act, 2004 40 South African Government News Agency, “Minister Clarifies Position on Social Relief of Distress Grants.” 41 Ibid.
17
● The applicant is awaiting payment of an approved social grant.
● The applicant has been found medically unfit to undertake remunerative work for a
period of less than 6 months.
● The breadwinner is deceased and application is made within three months of the date
of death.
● No maintenance is received from parent, child or spouse obliged in law to pay
maintenance, and proof is furnished that efforts made to obtain maintenance have
been unsuccessful.
● The breadwinner of that person’s family has been admitted to an institution funded by
the state (prison, psychiatric hospital, state home for older persons, treatment centre
for substance abuse or child and youth care centre).
● The applicant has been affected by a disaster as defined in the Disaster Management
Act or the Fund-Raising Act, 1978.
● The person is not receiving assistance from any other organization or
● Refusal of the application for social relief of distress will cause undue hardships.42
In response to the pandemic, SASSA has made SRD available to other groups, including
disability grant recipients whose grants lapsed in March 2020.43
Child Support Grant
The CSG is a child care assistance grant meant to “bridge the gap in the cost of
living” for parents.44 Much like SRD, the CSG is made unconditionally available only to
people who meet certain criteria. In order to qualify, the primary caregiver for a child —
42 South African Social Security Agency, “Social Relief of Distress Grant.” 43 Staff, “Covid-19 Lockdown.” 44 Department of Social Development, “SASSA Child Support Grant.”
18
defined as anyone who is largely responsible for looking after the child — must be a South
African citizen or permanent resident; must not be paid to look after the child; and must not
earn more than R48000 per year (if single) or have a combined income of more than R96000
a year (if married). If the applicant is not the child’s parent, documentary proof that (s)he is
the primary caregiver must be provided. On top of these requirements, eligibility is restricted
for children who are under 18 years of age and not in the care of a state institution.45
As of May 2020, the standard CSG award is R445 per month, per child.46 Because the
maximum income allowed for CSG recipients — equivalent to R4000 per month — is about
seven times higher than the FPL value of R561 per month, all South Africans living in
extreme poverty who meet the general eligibility requirements should in theory be able to
access the grant.
Proposals for General Reforms
In the following subsections, I will present two possible strategies for governmental
intervention using the CSG and SRD. Proposal 1 suggests converting SRD into a short-term
basic income for the very poor; Proposal 2 suggests SRD-accessibility for sub-FPL adults
without children and a topped-up CSG for sub-FPL households with children. Though these
strategies have the potential to support many millions of South Africans if implemented, the
proposed changes are not all-encompassing — effective implementation will require that the
government distribute SRD as cash, make remote grant registration and renewal possible, and
invest in local feeding schemes that can provide for the specific needs of communities across
South Africa. These changes will be addressed before social grant reforms are considered.
45 Ibid. 46 Pandemic-related changes to the grant in April 2020 will be addressed and analyzed in the conclusion.
19
SRD as Cash
In emergency circumstances, SRD is often delivered as a food parcel or voucher.
Bringing resources to families in need might seem ideal because it would relieve people of
the obligation to expend time, energy, and even money on collecting the grant from a
designated checkpoint, and providing a voucher seems to allow some degree of government
oversight of individuals’ uses of the funds. But the practical reality of food parcels and food
vouchers is ripe with complications of its own, some of which might compel a different
approach to aid.
Widespread distribution of food parcels has the potential to disrupt the local economy,
as essential businesses like grocery stores lose customers to bigger organizations that partner
with the government to provide the parcels. Besides, uniform food parcels can’t account for
the particular needs of any given household. Several analyses have shown that food parcels
— which are distributed by household and not necessarily modified for larger families — are
calorically deficient and nutritionally insufficient to last a family of four for a month.47 48 In
this sense, the government may be using funds inefficiently by supplying families with items
they don’t need while simultaneously depriving them of agency over their dietary needs.
Individual negligence can also result in delays and omissions: in 2016, thousands of food
parcels intended for distribution to HIV/AIDS patients were found rotting in a warehouse.49
More recently, reports of food parcels being stolen or distributed along party lines have
caused concern about the unmet needs of poor families.50 51
52
53 On top of these issues, one
47 Clifford, “Analysis: Are emergency food parcels from the Gauteng government ‘enough for one month’?” 48 Muller, Vermeulen, and Schönfeldt, “Food Aid Parcels in South Africa Could Do with a Better Nutritional
Balance.” 49 Beangstrom, “Food Parcels for HIV/Aids Patients Left to Rot.” 50 Makinana, “Harsh Consequences for ‘disgusting’ Food Parcel Thieves.” 51 Cruywagen, “#LOCKDOWN HUNGER CRIMES.” 52 Payne, “Western Cape legislature gets a picture of protests, looting and hunger in ‘land of milk and honey’.” 53 Nxumalo and Magubane, “KZN Ward Councillors Accused of Stealing Food Parcels Meant for the Poor.”
20
politician recently raised concerns about preserving dignity when “trucks [are] coming to
people’s houses showing that they are poor.”54
Food vouchers can also prove problematic under normal circumstances. Only certain
food distributors have agreements with SASSA that permit the use of SRD for clients’
needs;55 these locations may be more accessible for people living in or near urban centers,
which puts rural grant recipients at a disadvantage because of mere geospatial particularities.
While SASSA and the Department of Social Development can support clients’ transportation
needs through “petty cash”, this support is also conditional — recipients must be referred for
treatment by a medical professional or be traveling somewhere to accept employment that
represents independence from further State aid — and could quickly become a strain on
resources if expanded enough.56
Remote Application
Typically, in order to receive the CSG, a person must apply in-person at a SASSA
office and complete forms in the presence of an officer. The same is not explicitly specified
for SRD — but application forms are not available online for either grant. In order to
expedite the grant distribution process and encourage social distancing during the national
lockdown, individuals with internet access should be allowed to access SASSA forms online,
either to print and bring in or to submit electronically. SASSA should also set up temporary
outposts throughout rural communities in South Africa that are regularly staffed (even if not
full-time), such that nobody is required to travel a long distance to access or renew their grant
money.
54 Payne, “Western Cape legislature gets a picture of protests, looting and hunger in ‘land of milk and honey’.” 55 Portia Sehlabane, “Social Relief Distress as an Effective Strategy in Reducing Insecurity: The Perceptions of
Social Workers at the Department of Social Development, Johannesburg Metropolitan Area,” 40. 56 Portia Sehlabane, “Social Relief Distress as an Effective Strategy in Reducing Insecurity: The Perceptions of
Social Workers at the Department of Social Development, Johannesburg Metropolitan Area,” 40.
21
The Role of Feeding Schemes
Feeding schemes are a crucial part of the fiber of South Africa’s food ecosystem.
Because they specialize in supporting food insecure South Africans year-round, they are
better poised than governments to identify and address local needs. Among the largest
organizations conducting this work during the outbreak are:
● FeedSA, which has outlined a goal to distribute 5000 bulk packs (containing non-
perishable food, hygiene and sanitation items, and other “household essentials”) to
households across the townships during the outbreak. They have resorted to asking for
individual and corporate donations, stating on their website that each bulk pack costs
R480 and feeds a family of four for two weeks.57
● FoodForward SA, which has put out an appeal for R50 million in donations to
support their ongoing efforts to combat food insecurity during the outbreak.58 Beyond
distributing food to beneficiary organizations (BOs), they also have plans to establish
new branches in provinces where they don’t currently operate. As of April 6, 2020,
FoodForward SA had received R5.5 million in financial donations and R12 million in
food donations. In a newsletter, they noted that they have distributed “R1.8 million
worth of food to over 60,000 at-risk people via 150 of our most vulnerable BOs across
the country,” and that they have quickly established partnerships with hundreds of
new BOs for food distribution.
● The African Children’s Feeding Scheme (ACFS), which normally supplies 315
food parcels per month and feeds 10,000 children per day, is also appealing for
monetary donations in place of food donations (which their website says can’t be
accepted right now). In lieu of holistic needs assessments of schoolchildren and their
57 Feed SA, “FEED SA COVID19 ACTION PLAN.” 58 La Meyer, “COVID-19 Further Exposes the Fragility of Our Social Safety Net.”
22
families, as well as education and daily meals for toddlers and skills training for
mothers, they are making weekly food hampers available for pickup from their
Nutrition Centres. While there is no publicly accessible data on the number of food
hampers being made, they will include mielie-meal, rice, tinned beef, tinned fish,
baked beans, cooking oil, and other proteins and starches.59
The Peninsula School Feeding Association, Operation Hunger, Joint Aid Management, and
other groups are conducting similar campaigns. These organizations should continue to
operate during the pandemic, even if in limited capacity (i.e. by distributing food parcels), as
a supplement to the government cash-based measures. Their efforts should be supported by
government funds.60
Proposal 1: SRD as Means-Tested Basic Income
Using SRD as a means-tested basic income for the very poor while pausing all other social
protection programs for those below the FPL, allowing the government to focus most of its
resources for the very poor into one program.
The major benefit of investing in SRD as a COVID-19 response is that it has
heretofore represented a minor piece of social protection in South Africa, even though
SASSA reports that “the demand for SRD has been increasing over the years.”61 The lack of
a standard provision for SRD allows the government to set new precedents accounting for the
extenuating circumstances and leaves room for local agents’ advocacy in determining the
59 ACFS, “COVID-19 Crisis.” 60 Specific numbers will be discussed in the cost analysis portion of the paper. 61 South African Social Security Agency, “Annual Report 2017/18,” 20.
23
needs of the diverse groups that might apply for the benefit.62 Furthermore, SRD provides a
direct avenue for supporting vast swaths of the country’s population in the wake of a
pandemic — which is precisely the type of situation SRD is meant to address.
Practical Considerations
Duration. SRD’s temporal limitations set it apart from other grant programs in South
Africa. As a baseline, SRD provides three months’ worth of benefits, though grant
beneficiaries may apply for an extension to six months thereof.63 Under normal
circumstances, the brevity of the disbursement period for SRD is justifiable in light of its
target beneficiary: people facing immediate disaster circumstances or waiting for a separate
social grant.
But this duration can also be an impediment to sustainable well-being for grant
recipients, especially during a pandemic and a lockdown with no certain end. In a series of
interviews about SRD, one social worker voiced concern with the three-month support
period, even calling into question the effectiveness of the program because of its lack of
stability: “it is like we give our clients hope, then after that we take it.”64 Even more
distressingly, money received through SRD in the period before another grant is received can
be deducted from the forthcoming grant.65
Bureaucracy. Another barrier to the expansion of SRD is the nature of the
application and distribution process. Currently, families and individuals who wish to receive
support through the program must undergo a multi-level eligibility screening process. In an
interview with Sehlabane, one social worker detailed the steps involved:
62 Portia Sehlabane, “Social Relief Distress as an Effective Strategy in Reducing Insecurity: The Perceptions of
Social Workers at the Department of Social Development, Johannesburg Metropolitan Area,” 27. 63 Portia Sehlabane, “Social Relief Distress as an Effective Strategy in Reducing Insecurity: The Perceptions of
Social Workers at the Department of Social Development, Johannesburg Metropolitan Area,” 27. 64 Ibid., 43. 65 “Social Assistance.” Section 27.
24
“A social worker conducts an investigation and once they decide that the individual is
actually in need economically, the social worker then writes a report which the client
has to take to SASSA offices. Upon receiving the report from the social worker,
SASSA then conducts a further investigation to determine whether the client is in
need of the SRD. They do what is called screening. Once this is done, SASSA issues
the SRD for the client.”66
For a rapid expansion of the program to take place, in the absence of a shift away from such
thorough eligibility screening, it is extremely likely that the sector of social workers normally
engaged in the process would find itself overwhelmed and unable to process a large volume
of applications quickly enough for applicants to receive desperately-needed assistance. This
issue carries through to the potential for grant extensions, which are usually dependent on a
letter of motivation written by a social worker explaining why the recipient is still in need of
ongoing assistance through SRD.67
Subjectivity thus becomes a grave concern. There is also no standardized review
process; applicants are evaluated locally and approval is necessarily subjective. Because SRD
is “intended for people in extreme need who are unable to meet their or their families’ most
basic needs”68 — but the nature of that need is not explicitly defined — it is likely that
eligibility criteria and considerations of worthiness might be skewed across provinces and
localities.
66 Portia Sehlabane, “Social Relief Distress as an Effective Strategy in Reducing Insecurity: The Perceptions of
Social Workers at the Department of Social Development, Johannesburg Metropolitan Area,” 40. 67 Ibid., 40 68 “A useful guide for refugees, migrants & asylum seekers,” 15. Western Cape Government.
25
Remedies: In light of the above considerations, the government should take several steps to
best support the very poor during the outbreak:
(1) Ensure simplified SRD access for six months for anyone in need, and consider a
conditional extension beyond that period;
(2) Ensure that no money is lost from grants that SRD recipients qualify for in the
future;
(3) Implement a means test so that all South Africans earning less than R561 pppm
can automatically access the grant, but continue to evaluate other applications on a
case-by-case basis; and
(4) Ensure that SASSA offices are well-staffed and able to efficiently process grant
applications and disburse grant money while adhering to public health
recommendations.
Political Considerations
Duration. Politically, the temporal limitations could be valuable for two primary
reasons: (1) 3-6 months would likely give the South African government enough time to
monitor the development of the virus and evaluate the best long-term policy solutions without
abandoning its citizens in the short-term; and (2) the temporariness might make its
distribution more politically palatable for many South Africans who might worry about
dependency or take issue with longer-range social protection programs like the Child Support
Grant.
26
Proposal 2: SRD for Single Adults, Topped-Up CSG for Families
Making SRD available to single adults below the FPL while topping up the CSG
proportionally to household size and pausing all other social grants for the very poor during
the pandemic.
The major benefit of investing in the CSG is the distribution framework that was
already in place before the pandemic began. As the most well-funded social protection
program in the country, the CSG covers a significant portion of the South African population,
including over 65% of South Africa’s total population of children.69 In their letter to
Ramaphosa, academics called it “the simplest, quickest and most effective way to get cash
into millions of poor households that may well otherwise face food insecurity and debilitating
poverty.”70 Because many eligible families are already registered, it would be easy to identify
them and ensure that they receive extra funds (depending on their household size).
Practical Considerations
Use in households. It is widely understood that, while the CSG is distributed to
caretakers and intended to directly benefit children, it frequently becomes integrated into the
budget for entire households.71 Mothers receiving the grant reported that they already use it
for basic staples, most frequently spending the grant money on food and sometimes on school
items and transportation. But households with more kids are still more likely to face hunger
(source), and families whose kids are on the cusp of the age cutoff are at risk of losing a
stable source of financial support in an increasingly uncertain economic landscape.
69 “Child Support Grant (CSG).” SocialProtection.org. 70 Mathews et al., “Ramaphosa, Please Increase the Child Support Grant for the next 6 Months.” 71 Ibid.
27
Accessibility. Even as the largest grant program in SA, barriers to access abound —
beyond the standard waiting period of up to three months,72 mothers who reported not
receiving the CSG cited non-possession of identity documents, long lines, and administrative
delays and errors at offices.73 And though some academics claim that the economic security
provided by an augmentation in the CSG could also protect women and children from
violence associated with “poverty-related stresses and anxiety caused by the pandemic,”
Granlund and Hochfeld show that receipt of the CSG can also lead to tensions within
households. Most commonly, men might feel shame or even resentment at the “reversed
dependency” created by a grant that overwhelmingly goes to women, ultimately leading some
fathers to withhold monetary support for their children.74 It is unclear how the stress of a
pandemic might affect these internal politics.
Remedies: In light of the above considerations, the government should take several steps to
best support the very poor during the outbreak:
(1) Ensure that no money is lost from grants that SRD recipients qualify for in the
future;
(2) Top up the CSG according to household size;
(3) Temporarily loosen the age cutoff so that families with children who age out of
the CSG during the lockdown are still able to access the grant for six months;
(4) Work with community leaders to disseminate messaging making it clear that all of
the very poor will receive cash benefits, either through the CSG or through SRD, and
that communal cooperation is crucial during a lockdown; and
72 South African Government, “Child Support Grant.” 73 Zembe-Mkabile et al., “Why Do Families Still Not Receive the Child Support Grant in South Africa?,” 838. 74 Granlund and Hochfeld, “‘That Child Support Grant Gives Me Powers’ – Exploring Social and Relational
Aspects of Cash Transfers in South Africa in Times of Livelihood Change,” 9.
28
(5) Ensure that SASSA offices are well-staffed and able to efficiently process grant
applications and disburse grant money while adhering to public health
recommendations.
As well as the following modified steps from the previous section:
(6) Ensure simple SRD access for six months for any single adults in need, and
consider a conditional extension beyond that period;
(7) Implement a means test so that all South Africans earning less than R561 pppm
and not already receiving the CSG can automatically access the grant, but continue
to evaluate other applications on a case-by-case basis; and
Political Considerations
Use in households. The reality of CSG as a general household income constitutes
both a benefit and a challenge when it comes to the use of the CSG as a COVID-19 relief
measure: leaning on increased funding for the CSG might support a large swath of families in
the country, but it would also symbolize a state-level admission that the grant is not meant
only for children. Moreover, if CSG recipients come to rely on a greater provision from the
government during the outbreak, it is certainly possible that social and political unrest will
ensue when the government attempts to revert CSG funding to its pre-pandemic state —
especially if families are still suffering material consequences of the lockdown.
Cost Analysis
Seekings has noted that “affordability” can be viewed both as “an objective and
absolute binding constraint [and] as an entirely ideological or political choice or
29
preference.”75 Programmatic genesis and expansion in the social protection realm have
generally been catalyzed by improving public finances, as was the case when the age limit for
the CSG was doubled in 2003.76 But matters of budget reallocation are always a question of
political priorities — and pandemic politics are quite conducive to investment in money
distribution. As of April 10, 2020, 143 cash transfer programs had been introduced or adapted
in 83 countries, 65 of which were entirely new initiatives designed to respond to the COVID-
19 crisis.77 Nonetheless, in considering the adaptation of the South African social protection
scheme to the urgent needs at hand, standard expenditures must be understood.
As it stands, SRD is the social protection program that receives the least funding from
the South African government. The latest estimates for the 2019-20 fiscal year showed an
annual expenditure of R410 million on SRD (R34.2 million per month), or 0.23% of overall
spending on social protection programs. In contrast, R65 billion — 50% of overall social
protection spending and roughly 150 times more than SRD expenditures — were allocated
for the Child Support Grant, making it the country’s most well-funded social protection
program. Notably, while expenditures for almost every other grant program were expected to
increase over the next four years (with the exception of the Foster Care grant), expenditures
for SRD were projected to fall and then plateau.78 In order to use SRD to mitigate suffering
for the very poor across South Africa during the COVID-19 outbreak, the government will
need to shift course and invest in its expansion while also increasing CSG spending sooner
than projected by the Treasury Department.
75 Seekings, “Redefining the ‘affordability’ of Social Assistance Programmes,” 3. 76 Ibid., 11. 77 Gentilini et al., “Social Protection and Jobs Responses to COVID-19: A Real-Time Review of Country
Measures.” 78 “Budget Review, 2020,” 56. National Treasury.
30
Estimating the Financial Needs of the Very Poor
While the CSG uniformly awards R445 pppm to recipients, there is no apparent
standard value of SRD awards. We can determine an average award value of R1042 based on
SASSA’s annual expenditures and numbers of grants distributed, but this fails to account for
cost differences in the various non-cash forms of SRD (food vouchers, food parcels, and
school uniforms). As such, numerous possible thresholds for support will be proposed below.
Several figures can be used to determine the minimum amount of monetary support
that South Africans facing extreme poverty might need each month. As many South Africans
may find themselves newly unemployed in light of the lockdown, the following proposals
presume that recipients’ only source of income is the grant:
● A low-end estimate would be the FPL value itself — R561 pppm. While this should
allow families and individuals to support themselves nutritionally, it doesn’t account
for non-food expenditures (which would likely dig into the budget and reduce the
potential hunger-alleviating effects of a grant).
● Receiving the equivalent of the LBPL value, R810 pppm, would give recipients more
flexibility than the previous estimate but might still result in malnutrition because it
doesn’t factor in the true cost of basic non-food expenditures, such as electricity,
transportation, and education.
● Receiving the equivalent of the UBPL value, R1227 pppm, would in theory give
recipients enough funds to support themselves both nutritionally and materially.
● A high-end estimate would be the equivalent of the lowest National Minimum Wage:
R11.42 per hour, or roughly R1999 pppm (assuming a 5-day, 35-hour work week).79
This would provide a significant cushion for individuals and families struggling with
food insecurity.
79 South African Government News Agency, “Government Announces New National Minimum Wage Rate.”
31
These price points would lead to significantly altered expenditures on SRD and CSG, at least
for the duration of their provision during the lockdown — a period whose ultimate duration is
anyone’s guess. For the purposes of this analysis, costs will be projected for one month, three
months, and six months.
Cost Analysis (assuming 13.7 million people under FPL)
All units are
ZAR.
Normal
SRD
Normal
CSG
561
(FPL)
810
(LBPL)
1227
(UBPL)
1999
(NMW)
Time
Frame
1 month 34.2
million
5.4 billion 7.7
billion
11.1
billion
16.8 billion 27.4 billion
3 months 102.6
million
16.2 billion 23.4
billion
33.3
billion
50.4 billion 82.2 billion
6 months 205.2
million
32.4 billion 46.8
billion
66.6
billion
100.9
billion
164.3 billion
Prop
1:
SRD
monthly
change in SRD
spending
N/A
+7.7
billion
+11.1
billion
+16.8
billion
+ 27.4
billion
monthly
change in CSG
spending
–1.8 billion
Prop
2:
SRD
and
CSG
monthly
change in SRD
spending
N/A
+2.5
billion
+3.6
billion
+5.4 billion +8.8 billion
monthly
change in CSG
spending
+3.4
billion
+5.7
billion
+9.6 billion +16.8 billion
There are 6.4 million children living below the FPL.80 Applying the average CSG
uptake rate observed in a 2012 study across two provinces (62%) allows us to estimate that
just under 4 million children living in extreme poverty are receiving CSGs in any given
month. Multiplying by the standard CSG payment of R445 pppm indicates that the
government usually spends around R1.8 billion per month on CSGs for the very poor (out of
a total R5.4 billion monthly expenditure on the CSG). Estimates from the National Treasury’s
80 Shung-King et al., South African Child Gauge 2019, 222.
32
Budget Review indicated that R410 million would be spent on SRD in 2019/2020 — R34.2
million per month. Any of the proposed increases in SRD spending would place that number
in the billions, representing a drastic shift upwards.
The following evaluations use a low-end estimate of R561 for SRD and the CSG.
Under Proposal 1, using a R561-SRD grant as an opt-in means-tested basic income
(and pausing all other grants for the very poor) would increase SRD spending from R34.2
million per month to R7.7 billion per month, a 22414.6% shift. The move would also
directly result in lower expenditures across all other grant programs, including the CSG. CSG
spending would decrease from R5.4 billion per month to R3.6 billion per month, a 33.3%
reduction.
In order to understand the costs and savings associated with Proposal 2, it is first
necessary to understand the total number of sub-FPL individuals living in a CSG-eligible
household. A report in the 2018 Child Gauge indicates that 32% of households in South
Africa are one-person households or coupled households, meaning they have no children.81 82
Applying this proportion to the general population living in extreme poverty (13.7 million
people), we can assume that 4.4 million childless adults live under the FPL. This leaves 6.4
million children and 2.9 million adults living in CSG-eligible households under the FPL.
Following Proposal 2, offering a R561-SRD grant to all 4.4 million non-CSG-eligible
adults living in extreme poverty would increase SRD spending from R34.2 million per month
to R2.5 billion per month, a 7210.0% change. Assuming 100% uptake, the household-based
CSG top-up (to R561 pppm) would increase CSG spending from R5.4 billion per month to
81 Hall and Mokomane, “The Shape of Children’s Families and Households: A Demographic Overview,” 34. 82 The report also shows that 36% of households are extended and 2% of households are composite; both
categories could theoretically include households with children, but likely an insignificant proportion. As such,
these percentages are excluded from the calculation of non-child households under the FPL.
33
R8.8 billion per month, a 63.0% uptick. (This assumes R5.2 billion per month in CSG
expenditures for the 9.3 million people living in CSG-eligible households under the FPL.)
Excess Funds
Proposal 1 allows for some money to be saved in the temporary suspension of the
CSG and other grant programs that support the very poor. The South African government
could, of course, use these savings to fund the reformed (and costly) SRD grant program; but
it could also find other avenues through which to supplement the nationwide relief effort.
One option is fueling food parcel distribution efforts by local and regional feeding schemes,
which are already making fundraising appeals during the outbreak; the R1.8 billion saved in
Proposal 1 could pay for meals for millions of families (as a supplement to the cash being
received through SRD). Alternatively, topping up CSGs for the remaining 6.3 million
children receiving the CSG to R561 would extend the safety net and leave the government
with R936.8 million to invest elsewhere.
Conclusion
Desperation among the millions of South Africans living below the FPL is not new.
South Africa has struggled endlessly to escape the world’s deepest socioeconomic divide in
the 26 years since the end of apartheid,83 and those at the bottom of the ladder have been
forced to cut back on food and take on debt in order to survive.84 South Africa’s vast social
protection scheme can provide some relief for individuals and families in these
circumstances, but the novel coronavirus brings an entirely new set of challenges for the very
poor: in addition to a unique vulnerability to infection (due to communal living and
underlying health conditions), the national lockdown measures intended to protect the very
83 Gous, “SA Most Unequal Country in World.” 84 Staff, “This Is How Much Money the Poorest Are Living on Each Month in South Africa.”
34
poor also put them at risk of malnutrition. Given the epidemiological importance of social
distancing and self-isolation — and its harsh enforcement in South Africa85 — it is incumbent
upon the government to provide for the neediest members of society.
Through the proposals outlined in this section, Ramaphosa’s government can begin to
take steps to make social assistance accessible and useful for South Africans in extreme
poverty. Partnerships with community organizations must be fostered so that local needs can
be met on a case-by-case basis; the social grant application and renewal process must be
facilitated through remote means; and grants like SRD and the CSG must be altered to
provide adequate resources for households with no other stable income. Despite apartheid’s
persistent legacy of inequality, South Africa has made incredible strides in reducing poverty
over the last two decades.86 As widespread hunger mounts as a social concern, political
leaders should take swift action to ensure that this progress is not reversed.
85 Burke, “South African Police Fire Rubber Bullets at Shoppers amid Lockdown.” 86 Statistics SA, “Overcoming Poverty and Inequality in South Africa: An Assessment of Drivers, Constraints
and Opportunities.”
35
Works Cited
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https://www.westerncape.gov.za/assets/departments/local-
government/Publications/Awareness_Programmes/refugee_booklet_dec_2015.pdf
Beangstrom, Patsy. “Food Parcels for HIV/Aids Patients Left to Rot,” April 21, 2016.
https://www.iol.co.za/news/south-africa/northern-cape/food-parcels-for-hivaids-patients-left-to-
rot-2012664.
“Budget Review, 2020,” 56. National Treasury.
http://www.treasury.gov.za/documents/National%20Budget/2020/review/FullBR.pdf
Burke, Jason. “South African Police Fire Rubber Bullets at Shoppers amid Lockdown.” The
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https://www.theguardian.com/world/2020/mar/28/south-africa-police-rubber-bullets-shoppers-
covid-19-lockdown.
socialprotection.org. “Child Support Grant (CSG),” April 28, 2020.
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Clifford, Cayley. “Analysis: Are Emergency Food Parcels from the Gauteng Government ‘Enough for
One Month’?” Africa Check, April 24, 2020. https://africacheck.org/2020/04/24/analysis-are-
emergency-food-parcels-from-the-gauteng-government-enough-for-one-month/.
“Covid-19 Lockdown: Sassa Warns against Fake News about Food Parcels in KZN,” April 11, 2020.
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39
Chapter 2: Informal Workers
Julia Ilhardt
Abstract:
Informal employment represents a significant sector of the workforce in many countries around
the world, particularly amongst emerging economies. In South Africa, roughly 30% of
employment is informal – a relatively low proportion compared to neighboring African
countries. While the COVID-19 lockdown is expected to mean a loss of income for the roughly
70% of informal workers who are waged employees, these workers will be ineligible for
benefits from the Unemployment Insurance Fund (UIF). South Africa’s informal laborers are
often poor, young people in precarious living situations who do not receive other social grants,
making them particularly vulnerable to the economic shocks of the lockdown. Only 42% (13.8
million) of South Africa’s working-age population is formally employed and largely eligible
for the UIF under current circumstances, leaving a significant gap of the country unprotected.
Social protection interventions should focus on extending benefits to South Africa’s newly
unemployed informal laborers, which can be accomplished in a number of ways. First, the UIF
could be extended specifically to informal laborers with a flat-rate emergency grant, but this
option faces significant logistical challenges in identifying, registering, and provisioning funds
to the appropriate population. Second, the UIF could provide temporary emergency relief to all
poor, working-age South Africans who do not benefit from other social grants. Third, South
Africa’s most widely distributed social assistance program – the Child Support Grant (CSG) –
could be used as a proxy for benefiting the informally employed. A majority of informal
laborers live in households where someone receives a CSG and could theoretically benefit from
a supplemented grant, but this approach rests on assumptions about the use of grants as income
and the distribution of money within households. This chapter will provide background on the
state of the economy and employment in South Africa and will consider proposals aimed at
helping the informally employed within the context of international responses to COVID-19,
potential costs and limitations.
Introduction:
Following the example of countries around the world, South Africa imposed an initial
21-day national lockdown to limit the spread of COVID-19 beginning on March 24, 2020.
40
The strictly enforced lockdown has prohibited most activity outside of homes and has been
riddled with police brutality disproportionately impacting the poor.87 While South Africa’s
lockdown mirrors or exceeds that of places such as the United States and western Europe,
unlike many countries in the global north, approximately 30% of employment in South Africa
is informal. According to WIEGO, this accounts for nearly 5 million workers.88 Official
South African statistical reports define informal employment as all “precarious employment”
in the formal or informal sector where workers lack a contract and are not entitled to the
benefits of contributory, employment-related social protection programs such as old-age
pensions and unemployment benefits.89 This includes some street vendors, domestic workers,
people in the gig economy, and the self-employed, for example.90 The precarious working
population includes many poor and informally housed South Africans who depend on the
income from informal employment for survival, making informal workers and dependents
particularly vulnerable to both the health consequences of COVID-19 and the economic
consequences of the national lockdown. As part of South Africa’s emergency response to
COVID-19, this paper will consider means of adapting existing social assistance programs to
incorporate vulnerable informal laborers. Specifically, the chapter will look at ways to
expand the Unemployment Insurance Fund (UIF) or to supplement the Child Support Grant
(CSG) as avenues of providing assistance to those benefiting directly or indirectly from the
informal labor market.
87 Joseph Cotterill, “South Africa Uses Water Cannon and Rubber Bullets to Enforce Lockdown,” Financial
Times, March 29, 2020, https://www.ft.com/content/bad47729-32be-4865-b68a-27506158f023. 88 Mike Rogan, “Informal Workers in Urban South Africa: A Statistical Snapshot,” WIEGO Statistical Brief
(WIEGO, February 2019),
https://www.wiego.org/sites/default/files/publications/files/Informal%20Workers%20in%20Urban%20South%2
0Africa%20SB%2019.pdf. 89 “Quarterly Labour Force Survey: Quarter 4: 2019” (Pretoria, South Africa: Statistics South Africa, February
2020), http://www.statssa.gov.za/publications/P0211/P02114thQuarter2019.pdf. 90 When I refer to informal employment throughout this paper, it is according to this definition of the
precariously employed. This includes all South African workers who are excluded from unemployment
insurance.
41
With the lockdown in South Africa came the order that workers in non-essential
occupations stay at home, yet many informal jobs such as manual labor and street vending are
impossible to conduct remotely. A question, then, is whether informal laborers will adhere to
the lockdown, sacrificing work to stay at home. Further, it is unclear what percentage of
informal workers will be directly impacted by the lockdown. An Institute of Development
Studies article describes the difficult choice facing some workers, writing, “you are unsure
whether you have the virus; you may not be at health risk yourself; your life depends on your
job; and you are asked to forgo at least a proportion of your income to save other people in
your society. How likely are you to comply with the government recommendation?”91 In
other words, compensating for the losses to informal employment is essential for the health
and security of workers themselves as well as to ensure the efficacy of the lockdown in
limiting the spread of COVID-19 across the country.
The challenge of protecting the informal economy is not unique to South Africa but is
more exigent in countries with high rates of poor and informal workers left out of the
traditional social safety net. A 2018 International Labour Organization report found that 93%
of global informal employment is in emerging and developing countries and that poverty is
more common amongst these workers.92 While close to 86% of labor is informal in African
nations, countries in western and northern Europe have less than 15% informal employment.
In addition, potentially non-wage agricultural workers frequently experience the highest rates
of informality, but agriculture represents only 4% of South Africa’s informal employment.
Comparatively, 70.2% of South Africa’s informal laborers are “employees,” meaning they
91 Ayako Ebata, Philip Mader, and Gerald Bloom, “Precarious and Informal Work Exacerbates Spread of
Coronavirus,” Institute of Development Studies, March 23, 2020, https://www.ids.ac.uk/opinions/precarious-
and-informal-work-exacerbates-spread-of-coronavirus/. 92 “Women and Men in the Informal Economy: A Statistical Picture” (Geneva: International Labour Office,
2018), https://www.ilo.org/wcmsp5/groups/public/---dgreports/---
dcomm/documents/publication/wcms_626831.pdf.
42
likely receive a wage.93 Countries with large informal economies will have to develop
innovative strategies for accessing and provisioning funds to workers left without jobs or
security in the wake of the COVID-19 crisis. In South Africa, innovations must account for
potentially large numbers of newly unemployed, informal wage laborers who are not covered
by the social assistance infrastructure and who lack official income data.
The implications of the lockdown for the informal labor force has sparked significant
debate within South Africa. In an open letter to South African President Ramaphosa signed
by a coalition of unions and activist organizations, authors wrote of the influx of calls from
workers “dismissed or instructed to not show up for work, without pay or compensation.”
The letter states that “our work should not cost our lives.”94 Workers were sometimes asked
to test for COVID-19 without access to transportation or funds, forced to commute despite
the risks of infection, and limited from self-isolating. The letter asks that the Unemployment
Insurance Fund (UIF) – generally reserved for employees in the formal economy who are
terminated or unable to work – be extended to precarious workers. Around the world, the
rapid elimination of work opportunities caused by COVID-19 has placed incredible strain on
social assistance programs designed to support people in periods of unemployment. In the
U.S., the Economic Policy Institute wrote that “a greater share of Americans filed for
unemployment insurance in the week ending March 21 than in any prior week in American
history,” far outpacing the Great Recession or any natural disaster with 3.3 million new
claimants.95 This record was shattered the following week with 6.9 million new claimants,
93 “Women and Men in the Informal Economy: A Statistical Picture.” 94 “Covid-19: Open Letter to President Ramaphosa,” GroundUp News, March 24, 2020,
https://www.groundup.org.za/article/covid-19-open-letter-president-ramaphosa/. 95 Aaron Sojourner and Paul Goldsmith-Pinkham, “The Coronavirus Crisis Led to a Record-Breaking Spike in
Weekly Unemployment Insurance Claims: An Estimated 3.4 Million Workers Filed for Unemployment Last
Week,” Economic Policy Institute, March 24, 2020, https://www.epi.org/blog/coronavirus-record-breaking-
spike-in-ui-claims/.
43
and an estimated 17 million have applied for unemployment since the COVID-19 outbreak in
mid-March.96
While the U.S. approached the pandemic from a period of stable economic growth,
prior to the global outbreak of COVID-19, South Africa faced a recession and potentially
unsustainable levels of debt.97 In July of 2019, the country’s official unemployment rate hit
29% – its highest point since the 2008 financial crisis. This was accompanied by an increase
in UIF claims.98 Still, this narrow figure does not include persons who have given up looking
for work. Only about 42% of South Africa’s working age population is employed, meaning
29% of adults are left out of both the unemployment and employment figures.99 A March
2020 Bloomberg article stated that “the outbreak comes at a time when South Africa’s
National Treasury is severely constrained.” In February of 2020, South Africa’s Finance
Minister “proposed sweeping spending cuts to trim a fiscal deficit projected to widen to an
almost three-decade high.”100 Instead, the pandemic has tasked the government with
providing indefinite emergency relief to vast swaths of the population and procuring already
scarce funds. An added challenge is that 14% of households in South Africa live in informal
housing.101 Residents often lack the resources to obtain adequate food or health supplies, and
there may be minimal data on the status and needs of these populations.102 Informal housing
may complicate the targeted distribution of emergency funds.
96 David Harrison and Sarah Chaney, “U.S. Jobless Claims Soar for Third Straight Week,” Wall Street Journal,
April 9, 2020, sec. Economy, https://www.wsj.com/articles/u-s-surge-in-unemployment-claims-expected-to-
continue-11586424605. 97 Sibongile Khumalo, “South Africa in Recession after Shock Economic Slump,” Fin24, March 3, 2020,
https://www.fin24.com/Economy/South-Africa/breaking-south-africa-in-recession-after-shock-economic-slump-
20200303. 98 Mfuneko Toyana, “South African Unemployment Hits 11-Year High,” Reuters, July 31, 2019,
https://af.reuters.com/article/idAFKCN1UP0YL-OZATP. 99 “Employment Rate,” OECD, 2019, http://data.oecd.org/emp/employment-rate.htm. 100 Antony Sguazzin, “South Africa Unemployment Fund Plans $1.7 Billion in Virus Support,” Bloomberg,
March 27, 2020, https://www.bloomberg.com/news/articles/2020-03-27/s-africa-unemployment-fund-plans-1-7-
billion-in-virus-support. 101 “Has South Africa Built Enough Homes?,” BBC News, May 3, 2019, sec. Africa,
https://www.bbc.com/news/world-africa-48093711. 102 Cotterill, “South Africa Uses Water Cannon and Rubber Bullets to Enforce Lockdown.”
44
In selecting responses to COVID-19 that most effectively assist impacted populations,
there are a number of key challenges and perspectives to take into account. In a presentation,
Dr. Michael Samson of the Economic Policy Research Institute explained the need to
consider political will, financial constraints, and evidence gaps in the decision-making
process. Timeframe is another significant factor, with interventions ranging from the
immediacy of a lockdown to longer-term efforts to alter social norms. In other words,
interventions should not be proposed in a purely theoretical or idealistic way that neglects
contextual factors. In presentations, social protection policy experts emphasized the
importance of transforming COVID-19 responses to the circumstances and existing
legislative frameworks of individual countries. In South Africa, this means taking advantage
of widely distributed social grants and emergency reserves, of minimizing economic strain
while ensuring health services and resources are reaching the appropriate populations.
Overview of Proposals:
Those benefiting from informal employment in South Africa are not the only
vulnerable population in the midst of the COVID-19 pandemic, but South Africa’s existing
social safety net is ill-equipped to shield this group from the economic consequences of the
lockdown. A paper by Dawson and Fouksman states that “South Africa chose to implement a
system of social grants that explicitly excludes those who are physically capable of work.
Only ‘the deserving poor’ – the elderly, the disabled or children – receive welfare grants.”103
In supporting workers during periods of transitional unemployment, the UIF seems to be a
logical choice for providing aid to laborers in periods of crisis such as the COVID-19
103 H. J. Dawson and E. Fouksman, “Labour, Laziness and Distribution: Work Imaginaries among the South
African Unemployed,” Africa: The Journal of the International African Institute 90, no. 2 (March 25, 2020):
229–51.
45
pandemic, but the UIF would require significant alterations to extend to the informally
employed – a possibility which will be expounded later in the chapter. Still, South Africa is
not unique in its approach to informal employment.
The unemployment insurance system in South Africa is structurally similar to that of
many OECD countries, where both employers and employees contribute to the fund and the
state covers deficits. In some countries including the United States, employers exclusively
fund the unemployment insurance schemes. In general, unemployment insurance is less
developed in Latin American countries, with programs that cover only workers in the private
sector. Dupper et al. writes that “unemployment insurance funds invariably do not cover
members of the informal sector, and this is especially the case for developing countries that
have large informal sectors.”104 Informal laborers often lack the ability to invest in individual
savings accounts, and short-term or unofficial contracts minimize the responsibility of
employers. Self-employed workers also tend to be excluded from unemployment insurance,
with the exception of a few programs in OECD countries organized on a voluntary basis.105
In South Africa, the current UIF thus represents an important but inadequate basis on which
to develop a COVID-19 response targeting populations with disrupted revenue streams.
A key issue in adapting South Africa’s social assistance for the informally employed
is identifying and reaching the particular population of interest. As will be discussed in the
following section, South Africa already began expanding UIF grant availability for
businesses and workers affected by COVID-19 and qualified under present UIF guidelines.
However, an estimated 45% of South African workers – including the informally employed –
will not be eligible for this assistance. Without emergency assistance, amongst households
104 Avinash Govindjee, Ockert Dupper, and Marius Olivier, “Extending Coverage of the Unemployment
Insurance-System in South Africa,” Stellenbosch Law Review 21, no. 3 (2010): 438–62. 105 Govindjee, Dupper, and Olivier.
46
depending on informal labor, extreme poverty could rise from 10% to 26%.106 A variety of
options exist for extending assistance to the informally employed, including using existing
grants as a proxy to benefit households containing informal laborers.
First, South Africa could use surplus from the UIF to extend the program to
unemployed informal workers. Ideally, this would be through an emergency relief grant
directly targeted at the newly unemployed. Considering the COVID-19 legislative responses
in countries such as Argentina, El Salvador, and Egypt, this form of program is not without
precedent. However, this approach faces significant logistical burdens, including the need to
register and approve individuals for a new social grant. Alternatively, a temporary
unemployment grant could be given to all working-age South Africans below a certain
income threshold and not receiving other grants, encompassing most newly unemployed
informal workers. Comparisons for such a program can be drawn from the U.S. and Namibia.
However, some argue that “supporting informal workers directly through unemployment
benefits or new targeted grants would be extremely difficult. These workers are unregistered,
untaxed and undocumented.”107 As a third optionn, the Child Support Grant (CSG) could be
topped up in the hope of catching the majority of households previously benefiting from
informal employment. Using the CSG would take advantage of South Africa’s broad social
assistance infrastructure, building on one of the country’s largest transfer programs. Yet this
approach makes assumptions about the diffusion of grants as household income and incites
debates about a ‘culture of dependency’ and kinship networks.
Expanding the UIF:
Background:
106 Ihsaan Bassier et al., “South Africa Can – and Should – Top up Child Support Grants to Avoid a
Humanitarian Crisis,” The Conversation, March 31, 2020, http://theconversation.com/south-africa-can-and-
should-top-up-child-support-grants-to-avoid-a-humanitarian-crisis-135222. 107 Bassier et al.
47
South Africa’s Unemployment Insurance Fund is governed by the Unemployment
Insurance Act of 2001 and the Unemployment Insurance Contributions Act of 2002. The UIF
represents South Africa’s only social insurance program for the unemployed, and potentially
one of the only grants available to working-age men.108 According to the South African
Revenue Service, the UIF “gives short-term relief to workers when they become unemployed
or are unable to work because of maternity, adoption leave, or illness.”109 Almost all formal
employees and employers are required to contribute to the UIF, and the amount and duration
of payments depends on the worker. Workers are eligible for one day of UIF benefits for
every six days employed, up to a maximum of 238 days. UIF payment amounts are a
proportion of the worker’s salary, with higher proportions for low-income claimants.110 In
theory, this should make UIF benefits progressive in favor of the poor. However, in 2013 the
Brookings Institution found that “women, youth, poorer claimants and contract employees
face the lowest potential claim days when claiming their benefits.” Further, “those with the
lowest potential claim periods were also subject, on average, to lower absolute benefits
compared to their wealthier counterparts.”111
Importantly, only a subset of formal workers maintain eligibility for the UIF. The UIF
is not available to the unemployed who have never worked before and is not available to
those working in the informal sector, representing amongst “the most vulnerable unemployed
labor market participants in South Africa.”112 Further, claimants are required to have been
formally employed for at least 24 hours per month prior to filing for the UIF. This provision
108 Haroon Bhorat, Sumayya Goga, and David Tseng, “Unemployment Insurance in South Africa: A Descriptive
Overview of Claimants and Claims” (Brookings Institution, April 2013), https://www.brookings.edu/wp-
content/uploads/2016/06/04_unemployment_insurance_south_africa.pdf. 109 “Unemployment Insurance Fund,” SARS, November 9, 2020,
https://www.sars.gov.za/TaxTypes/UIF/Pages/default.aspx. 110 Bhorat, Goga, and Tseng, “Unemployment Insurance in South Africa: A Descriptive Overview of Claimants
and Claims.” 111 Bhorat, Goga, and Tseng. 112 Bhorat, Goga, and Tseng.
48
is meant to avoid economic inefficiencies and administrative costs. According to Dupper et
al., a disadvantage is that “a person who works for various employers for short monthly
periods, remains excluded even though he or she may be fully, or nearly fully, employed.”
The authors add that women are disproportionately represented in this category, potentially
maintaining part-time or precarious jobs not covered by social security programs.113 South
Africa now requires that domestic workers be registered for the UIF, though more than
300,000 domestic workers out of one million total are thought to be left out.114 The UIF is
relatively small compared to social grants such as the CSG and the Old Age Pension,
reaching approximately 60,000 beneficiaries per month and paying out about 9.2 billion rand
per year as of 2018.115 The UIF could be paid for reasons of unemployment, but also for sick
leave, maternity, or adoption leave.116 The program has over 8 million workers currently
registered on its database.117 This means that the UIF is available for about 21% of South
Africa’s working age population, and about 60% of the country’s formally employed.118
Nevertheless, the UIF has become central in South Africa’s emergency response to COVID-
19.
As part of South Africa’s initial national lockdown, the government staggered social
grant delivery and slightly increased grant amounts to try to limit the gathering of crowds and
cushion the economic blow of the closures.119 This approach had some success but was
113 Govindjee, Dupper, and Olivier, “Extending Coverage of the Unemployment Insurance-System in South
Africa.” 114 Kristine Liao, “One Third of Domestic Workers Are Not Registered for UIF,” Sunday Times, June 13, 2019,
https://www.timeslive.co.za/news/south-africa/2019-06-13-one-third-of-domestic-workers-are-not-registered-
for-uif/. 115 “Unemployment Insurance Fund (UIF) Annual Report 2017/18” (Department of Labour, n.d.). 116 “Unemployment Insurance Fund.” 117 “Here’s How Many South Africans Applied for Coronavirus Employee Funding – and Why Some
Applications Failed,” Business Tech, April 21, 2020, sec. Business,
https://businesstech.co.za/news/business/391105/heres-how-many-south-africans-applied-for-coronavirus-
employee-funding-and-why-some-applications-failed/. 118 “Working Age Population,” OECD, n.d., http://data.oecd.org/pop/working-age-population.htm. 119 “Social Grants - Coronavirus COVID-19,” South African Government, n.d.,
https://www.gov.za/coronavirus/socialgrants.
49
insufficient to protect the health and stability of poor, potentially unemployed South Africans.
On March 20, 2020, a collection of organizations representing informal laborers called on the
government to “make urgent arrangements to redirect funds away from the UIF surplus, and
from large events that have been cancelled, and other sources, to establish a Living Cash
Grant to all informal workers, regardless of nationality.”120 Based on this letter, informal
labor advocates support the proposal of a targeted offshoot of the UIF specifically benefiting
informal workers.
Further pressure to expand the UIF came from the Congress of South African Trade
Unions and Business Unity South Africa, both groups with considerable political influence.
While some South African programs faced fiscal strain prior to COVID-19, the UIF had a 30
billion rand surplus available for emergency funds and, according to the UIFs former
director, up to 160 billion rand in investments.121 The UIF set aside 30 billion rand for a new
program called the Temporary Employee Relief Scheme (TERS), meant to replace the
incomes of workers laid off as a result of COVID-19. TERS bears similarities to the U.S.
Families First Coronavirus Response Act, which devotes an initial $1 billion to states
attempting to meet enormous demands for unemployment insurance.122 However, companies
have struggled to access TERS funds due to a lack of government support, confusing
documentation requirements, and unclear application instructions.123 As of April 21, 55, 268
employers had applied for UIF funding under TERS and 37,673 applications were approved.
120 “The Impact of COVID19 on the Millions Who Work Informally in South Africa” (SAWPA, WIEGO et al.,
March 20, 2020), https://lrs.org.za/media/2020/3/02da98c3-c905-469b-aadb-d7e646928871-
1584784593430.pdf. 121 Ray Mahlaka, “UIF Has R30bn Available for Covid-19 Income Support to Laid-off Workers,” Daily
Maverick, April 1, 2020, https://www.dailymaverick.co.za/article/2020-04-01-uif-has-r30bn-available-for-
covid-19-income-support-to-laid-off-workers/. 122 Maurice Emsellem and Michele Evermore, “Understanding the Unemployment Provisions of the Families
First Coronavirus Response Act,” National Employment Law Project, March 2020,
https://www.nelp.org/publication/understanding-the-unemployment-provisions-of-the-families-first-
coronavirus-response-act/. 123 Tanya Steenkamp, “Covid-19: How to Apply for the UIF Relief Benefit,” Times LIVE, April 3, 2020,
https://www.timeslive.co.za/news/south-africa/2020-04-03-covid-19-how-to-apply-for-the-uif-relief-benefit/.
50
This represents benefits for more than 600,000 workers.124 While it is an important medium-
term goal to shield South Africa’s precarious economy from the shocks of lockdown, overly
burdensome restrictions will limit the flow of needed resources towards companies and
employees. Some have advocated for a ‘pay now, verify later’ approach to social protection
under COVID-19, distributing funds as quickly as possible and correcting mistakes in the
future. One article by Economics for Inclusive Prosperity wrote that “unemployment offices
should presume that all applicants are eligible and prioritize paying claims without careful
review.”125 While some administrative oversight is essential, COVID-19 programs should
aim to strike a balance between the rapid distribution associated with logistical simplicity and
the targeting of particularly vulnerable populations. The following sections will consider two
methods for expanding the UIF to reach the informally employed, the first with an emphasis
on specificity and the second with a focus on simplicity.
Targeted grant for informally employed:
Ideally, an expanded UIF would be provisioned directly to those informal laborers
who have become unemployed as a result of the COVID-19 lockdown. While there is no
official record of this population, it will be assumed that the approximately 70% of salaried
informal workers in South Africa lost income due to the lockdown. This then constitutes a
group of roughly 3.5 million people. To understand how the UIF might be expanded to
informal workers via a targeted grant, one can look to the actions of other countries in
response to COVID-19.
124 “Here’s How Many South Africans Applied for Coronavirus Employee Funding – and Why Some
Applications Failed.” 125 Arindrajit Dube and Jesse Rothstein, “Pay Now, Verify Later to Loosen the Unemployment Insurance
Bottleneck,” Economics for Inclusive Prosperity, March 2020, https://econfip.org/policy-brief/pay-now-verify-
later-to-loosen-the-unemployment-insurance-bottleneck/.
51
Argentina, for example, created an Emergency Family Income to provide a one-time
payment of 10,000 pesos to 3.6 million people benefiting from informal income.126 Argentina
already had a fairly extensive social protection system originating from around 2001, when
poverty levels topped 50%.127 And similar to South Africa, in response to COVID-19,
Argentina supplemented a child support grant that reaches 2.2 million parents monthly as
well as the pensions of 4.6 million residents. The Emergency Family Income, though, is
intended specifically for workers “who do not receive pensions or subsidies of any kind and
who have no other income.” Workers registered for the program online, and Argentina
analyzed family units to ensure that relatives did not receive grants or other substantial
incomes.128 In practice, it is unclear how Argentina distinguished the unofficially employed
from the unemployed for those without tax records, meaning the grant may have been
distributed beyond just informal workers. Still, highlighting informal workers as the intended
target of emergency relief may make the program more palatable for lawmakers aiming to
bolster the economy and support the ‘deserving’ employed. Considering the political
feasibility of such a grant, Argentina is perhaps a good comparison for South Africa in that
both countries maintain large public works programs and a rhetorical focus on the need for
the poor to find employment.129
Another country which emphasizes its large public works program is El Salvador,
which has taken a unique approach to targeting aid for the informally employed. El Salvador
announced that “more than 1.5 million people who consume less than 250 kilowatts of
126 Federico Rivas Molina, “Argentina extiende la ayuda social a cerca de cuatro millones de trabajadores
informales,” EL PAÍS, March 24, 2020, https://elpais.com/economia/2020-03-24/argentina-extiende-la-ayuda-
social-a-cerca-de-cuatro-millones-de-trabajadores-informales.html. 127 Molina. 128 “Coronavirus En Argentina: El Estado Les Pagará 10 Mil Pesos a Trabajadores Informales y
Monotributistas,” Clarín, March 23, 2020, https://www.clarin.com/politica/coronavirus-argentina-gobierno-
anuncia-medidas-pymes-monotributistas-trabajadores-informales_0_dpIkoiBC-.html. 129 Esther Gehrke and Renate Hartwig, “Productive Effects of Public Works Programs: What Do We Know?
What Should We Know?,” World Development 107 (July 1, 2018): 111–24,
https://doi.org/10.1016/j.worlddev.2018.02.031.
52
electrical energy monthly would receive a US $300 bonus to compensate for the work
stoppage that will mainly affect those who engage in informal commerce.”130 In other words,
energy was used as a proxy for identifying those benefiting generally from the informal
economy. It is again unclear how well energy serves as a metric for informal labor
dependence, but such a system is also possible in South Africa where an estimated 87% of
households have access to electricity.131 Distribution of the grant in El Salvador for those
without bank accounts proved problematic, with claimants crowding offices to obtain
vouchers and El Salvador temporarily suspending the program.132 Using utilities as a means
of identifying need, though, is another viable option for South Africa.
In Egypt, a one-time cash grant has been implemented for workers in the informal
sector who register online with the Ministry of Manpower and are approved by a
“government committee.” Some 1.5 million workers have registered, but the grant is seen as
too small to cushion the economic blow of lost income.133 Further, approximately 11.9
million Egyptians work in the informal economy.134 This form of program is administratively
burdensome and limited in scope, and would be ineffective in aiding most informal laborers
in South Africa. South Africa could, however, create an emergency relief grant through the
UIF using income or some form of consumption as a metric and specifically target informal
workers. This grant would likely have to be a fixed cash transfer rather than the traditional
130 “Cómo Puede La Pequeña Economía de El Salvador Costear El Ambicioso Plan de Bukele Para Frenar El
Impacto Del Coronavirus,” BBC News Mundo, March 25, 2020, sec. América Latina,
https://www.bbc.com/mundo/noticias-america-latina-52013943. 131 “Tackling Urban Energy Poverty in South Africa” (Cape Town: Sustainable Energy Africa, 2014),
https://www.sustainable.org.za/uploads/files/file72.pdf. 132 Anastasia Moloney, “Lockdown Broken in El Salvador as Crowds Gather for Government Aid,” Reuters,
March 30, 2020, https://www.reuters.com/article/us-health-coronavirus-elsalvador-trfn-idUSKBN21H3IB. 133 Ayat Al Tawy, “Coronavirus or Hunger: Workers in Egypt’s Vast Informal Economy Struggle to Survive as
Pandemic Bites,” Ahram Online, April 7, 2020,
http://english.ahram.org.eg/NewsContent/1/64/366843/Egypt/Politics-/Coronavirus-or-hunger-Workers-in-
Egypt%E2%80%99s-vast-info.aspx. 134 Mada Masr, “Egypt Authorities Take Additional Measures to Curb Coronavirus Spread and Stimulate
Economy,” Mada Masr, March 19, 2020, https://madamasr.com/en/2020/03/19/feature/politics/egypt-
authorities-take-additional-measures-to-stimulate-economy-and-curb-coronavirus-spread/.
53
income adjusted UIF payment because there is a lack of data on the incomes of the informally
employed.
Universal grant for low-income, working age South Africans:
In practice, it is essentially impossible for the South African government to
distinguish working informal laborers from newly unemployed informal laborers from the
long-term unemployed poor. An alternative option, then, is to benefit the informally
employed by providing a grant to all poor South Africans currently excluded from social
protection programs. This could take a form similar to a universalized low-income grant, but
with the stated purpose of targeting the informally employed and replacing lost income. A
partially universalized approach has significant administrative advantages, requiring no proof
of employment or the involvement of in-person application reviewal, which would likely
violate lockdown guidelines.
A comparable program has been established in the U.S., representing what is
essentially a universal grant for low-income Americans. Barring certain exceptions, in the
U.S., an individual adult whose tax returns demonstrate an income lower than $75,000 in
2019 should receive $1,200 directly to their bank account. Although gig workers and the self-
employed are generally ineligible for unemployment insurance, the grant will also cover
them. For people who have not completed tax returns, they may still be eligible by
completing an online form. Critically, migrants and those without a Social Security number
will be excluded.135 While this is only a segment of the U.S. stimulus package in response to
COVID-19, it may be one of the most significant for capturing the informally employed. If
implemented in South Africa, a key consideration will be how to ensure that all low-income
135 Li Zhou and Ella Nilsen, “How to Get Your Stimulus Check, and Other Key Questions, Answered,” Vox,
April 14, 2020, https://www.vox.com/2020/4/14/21220468/coronavirus-stimulus-check-irs-eligibility-timing.
54
residents who do not necessarily appear in tax or social security databases will receive the
grant. One option is to offer the grant via online or in-person registration to those without tax
returns. A model for such a program comes from Namibia, bordering South Africa and likely
bearing more sociocultural similarities to South Africa than the U.S.
Namibia implemented an “Emergency Income Grant” of N$750 for all residents aged
18-59 who received no other social grants and were not employed in the formal sector. This
grant targeted those “employed or self-employed in the informal sector [who] have lost
income during the lockdown period” as well as the working-age unemployed.136 Applicants
applied via SMS and had to provide a Namibian ID number, and payment was made to
electronic wallets or was redeemable at ATMs regardless of the existence of a bank account.
750,000 Namibians are thought to be eligible, and 350,000 initial applicants were rapidly
processed with nearly 147,000 receiving the grant as of April 16.137 A similarly broad
program may be feasible in South Africa, with self-registration overcoming the challenges of
population identification.
Costs and Implementation:
In South Africa’s COVID-19 response thus far, legislators have demonstrated a desire
and willingness to expand the UIF, seemingly responding to the demands of business
associations and prioritizing the country’s economic stability. While the UIF has not yet been
adapted to help the informally employed, by focusing assistance around traditional narratives
of temporarily supporting and supplementing work, a UIF expansion may be politically
feasible. In addition, cash transfers for vulnerable workers benefit the public health broadly
by limiting movement and social interaction through work. This chapter first considered an
136 “Frequently Asked Questions about the Emergency Income Grant of the Economic Stimulus and Relief
Package” (Republic of Namibia: Ministry of Finance, n.d.). 137 Yokany Oliveira, “First Batch of Grant Beneficiaries Paid,” The Namibian, April 16, 2020,
https://www.namibian.com.na/index.php?page=read&id=90270.
55
expansion of the UIF specifically targeting newly unemployed informal laborers. However,
the logistical challenges associated with registering and paying the target population make
this an infeasible option. Instead, the informally employed could be reached through a grant
for poor, working-age South Africans who are not beneficiaries of other social protection
programs.
First, it is necessary to estimate how many residents may be eligible for this grant.
The program could reasonably be limited to people 18-59 years old, catching most who have
finished high school, aged out of the Child Support Grant, and not yet aged into pension
programs. Close to 33 million South Africans fall within the 18-59 age bracket.138 The 13.1
million South Africans who filed personal income tax forms in 2019 would be excluded from
this grant, likely covered by the UIF or making higher incomes.139 Use of the existing tax
database also simplifies the process of checking expanded UIF applicants against registered
taxpayers. Also excluded would be roughly 7 million CSG caregiver recipients140 and 1
million disability grant recipients.141 Overall, this means that approximately 12 million
people would be eligible for the grant. Similar to Namibia, applicants could register via
phone or online with a South African ID number and quickly checked against tax and social
grant databases, then receive the grant electronically or redeemable at ATMs.
A significant question is where this informal worker grant would need to be set.
Although the UIF is traditionally based on a worker’s previous salary, this is impossible to
verify with informal laborers. One option is to set the cash transfer amounts at the monthly
138 “Mid-Year Population Estimates,” Statistical Release (Statistics South Africa, 2019),
https://www.statssa.gov.za/publications/P0302/P03022019.pdf. 139 “Tax Statistics 2019” (South African Revenue Service; National Treasury, December 2019),
https://www.sars.gov.za/AllDocs/Documents/Tax%20Stats/Tax%20Stats%202019/Tax%20Stats%202019%20F
ull%20doc.pdf. 140 Jeremy Seekings, “South Africa: COVID-19 - Ramaphosa’s Plan Is Good, but the Budget Is Insufficient,”
allAfrica.com, April 23, 2020, https://allafrica.com/stories/202004230954.html. 141 “CORRECTION: SA Pays out 17.2 Million Social Welfare Grants to 10.6 Million Beneficiaries,” Africa
Check, March 8, 2017, https://africacheck.org/spot-check/correction-sa-pays-17-2-million-social-welfare-
grants-10-6-million-beneficiaries/.
56
level of the CSG (440 rand). In the unlikely event that all 12 million eligible applicants
register for the expanded UIF, this would then cost R5.28 billion per month. This is still far
below the existing 30-billion-rand surplus in the UIF. If a grant is instead set at the level of
South Africa’s Old Age Pension (1860 rand), the program would cost R22.32 billion per
month. The pension scheme is considered generous, and many of South Africa’s laborers
earn poverty-level incomes.142 For example, Dawson and Fouksman write that precarious
roadside jobs in an informal settlement such as construction and gardening pay between 50
and 250 rand per day.143 A modest grant for informal workers could thus still have a
significant impact on economic stability.
Shortcomings:
While focusing a grant on replacing the incomes of informal workers as opposed to
supplementing existing programs or creating a universal basic income may have political
benefits, a significant question is whether working-age men would want to receive a grant.
Dawson and Fouksman interviewed unemployed young men in South Africa, many of whom
were “concerned with the moral consequences of welfare abuse and laziness, and [held]
strong beliefs that income should not come without work.” These men preferred government
jobs, training, and education to cash transfers. One interviewee stated that existing grants
facilitated the destruction of gender and social norms, echoing a traditional male breadwinner
sentiment. Even a universalized program could prove unpopular, with Dawson and Fouksman
writing that “South Africa seriously considered implementing a small universal basic income
grant in the early 2000s, but rejected the proposal, despite widespread support from labour
unions and civil society. Instead, South Africa chose to implement a system of social grants
142 Caroline Skinner and Mike Rogan, “South Africa’s Informal Sector Creates Jobs, but Shouldn’t Be
Romanticised,” The Conversation, n.d., http://theconversation.com/south-africas-informal-sector-creates-jobs-
but-shouldnt-be-romanticised-122745. 143 Dawson and Fouksman, “Labour, Laziness and Distribution.”
57
that explicitly excludes those who are physically capable of work.”144 Still, countries with a
similar emphasis on workfare and the deserving poor such as the U.S. and Argentina have
successfully implemented programs benefiting the informally employed. By touting these
grants as emergency relief and income replacement, some of the concern about ‘laziness’ and
‘dependency’ may be mitigated. Cash transfers might also be partially replaced by healthcare
subsidies or food vouchers for the poor.
An additional and persistent challenge in creating a new grant is registration,
administrative oversight, and distribution. If registration required completing an online form,
roughly 40% of the population would not have access (though more may be reached through
smartphones).145 Other eligible recipients could be accessed through South Africa’s Social
Security Administration offices, but risk violating social distancing guidelines. If regulators
are required to rule on the awarding of applicants, administrative costs could also rapidly
increase. However, determining eligibility for a broadly expanded UIF should be relatively
straightforward via comparison with tax and social grant databases. This proposal risks
excluding some informal laborers who are beneficiaries of other grants such as the CSG, but
the expanded UIF would catch many of those without alternative income to fall back on.
Compared to the UIF, the fundamental advantage of the following proposal to expand the
CSG is its logistical simplicity.
Supplementing CSG:
Background:
144 Dawson and Fouksman. 145 “South Africa: Internet Penetration 2023,” Statista, n.d., https://www.statista.com/statistics/484933/internet-
user-reach-south-africa/.
58
The Child Support Grant (CSG) is South Africa’s most extensive social assistance
program, costing 60.6 billion rand in 2018, or over 1.5% of GDP.146 The CSG and the Old
Age Grant (OAG) are the country’s most expensive social security schemes, but the CSG
covered nearly 12 million children in 2015. That coverage represented over 65% of South
Africa’s total population of children.147 Still, while the OAG currently provides 1,860 rand
per month ($101.81), the CSG provides only 440 rand per month ($24.08).148 Historically, the
CSG has been expanded for a number of complex political reasons and has faced mixed
reviews in its capacity to provide women with sustenance, autonomy, and dignity. For
example, a paper by Wright et al. states that “[w]omen reported being made to feel unworthy
by being required to queue for very lengthy periods, having to negotiate burdensome and
unclear qualifying criteria, and being treated disrespectfully by government officials.” Still,
the paper later says that “[g]rant receipt served to elevate consumption and ameliorate
poverty, allowing recipients to discharge their childcare responsibilities, act in ways
congruent with the maternal role and, finally, exercise individual agency.”149
Nevertheless, the CSG provides an extremely useful network on which to develop a
COVID-19 response. In a presentation on social protection in the time of coronavirus,
Valentina Barca discussed the challenges of identifying, registering, and distributing
resources to the vulnerable populations most impacted by COVID-19 lockdowns. While
imperfect, the South African Social Security Administration (SASSA) already has a broad
and well-established payment system. An article by The Conversation explains that amongst
the poorest half of South Africans, 80% of households including an informal worker are
146 “Annual Report 2018-2019” (South African Social Security Agency, n.d.),
https://www.sassa.gov.za/annual%20reports/Documents/SASSA%20Annual%20Report%202018-2019.pdf. 147 “Child Support Grant (CSG),” socialprotection.org, n.d., https://www.socialprotection.org/programme/child-
support-grant-csg. 148 “Social Grants - Coronavirus COVID-19.” 149 Gemma Wright et al., “Social Assistance and Dignity: South African Women’s Experiences of the Child
Support Grant,” Development Southern Africa 32, no. 4 (July 4, 2015): 443–57,
https://doi.org/10.1080/0376835X.2015.1039711.
59
households in which someone receives the child support grant.150 An argument, then, is that
although the CSG is not targeted at informal workers, it can be used to reach many South
African residents who depend on income from informal employment.
In a letter to President Ramaphosa, a coalition of advocates argued that “the child
support grant is the simplest, quickest and most effective way to get cash into millions of
poor households that will otherwise face food insecurity and debilitating poverty.” The letter
called for a 500 rand per month increase to the CSG, currently set at 440 rand per month.151
The coalition explained that during the course of the lockdown, food poverty could double
amongst households depending on income from informal labor, potentially impacting
“millions of children” but providing no specific estimate as to the consequences for CSG
beneficiaries. In theory, increasing the CSG would benefit children previously receiving
school meals and education, but would also “become part of household budgets and help to
support entire households.”152 Because of the simplicity of topping up social benefits, this
strategy has been implemented in numerous countries around the world. These include
Belgium, Brazil, China, Indonesia, and others.153 There is a political incentive to appease the
demands of CSG advocates, and an expanded CSG may minimize calls for a Living Cash
Grant or universalized aid program.
Costs and Implementation:
150 Bassier et al., “South Africa Can – and Should – Top up Child Support Grants to Avoid a Humanitarian
Crisis.” 151 Andisiwe Makinana, “Government Considering Increasing Child and Pension Grants Temporarily,” Times
LIVE, April 14, 2020, https://www.timeslive.co.za/politics/2020-04-14-government-considering-increasing-
child-and-pension-grants-temporarily/. 152 “Letter to Mr President: Call to Increase the CSG to Protect Children and Families,” Children’s Institute,
April 4, 2020, http://www.ci.uct.ac.za/news/letter-to-president-to-increase-CSG. 153 Ugo Gentilini et al., “Social Protection and Jobs Responses to COVID-19: A Real-Time Review of Country
Measures,” April 10, 2020.
60
Adhering to advocate recommendations to supplement the CSG by 500 rand per
month for six months, the University of Cape Town Children’s Institute estimates a total cost
of 40 billion rand. This paper states that extending the increase for six months could “serve a
stimulus role to reignite the economy,” arguing that poor households would have more
income for consumption spending which would offset some future economic consequences of
the lockdown.154 It is yet unclear whether supplementing the CSG would have broad
economic repercussions beyond helping many of South Africa’s very poor. Potential funding
sources include the UIF surplus and the newly created Solidarity Fund. South Africa created
the Solidarity Fund primarily through donations and 150 million rand from the government.
Most of this fund is intended to purchase “personal protective equipment, sanitizers and
medical supplies, or to support affected businesses with soft loans.”155 The Solidarity Fund
would need to be significantly expanded and reoriented to meet the demands on the CSG, and
the supplemented grant would likely require alternative funding sources. The costs of
increasing an already extensive social assistance program may hinder political support. In
terms of implementation, the increased CSG proposal benefits from requiring essentially no
alterations.
Shortcomings:
An important consideration for this approach is whether an expanded CSG would
truly diffuse throughout poor and informal labor-dependent households. And further, it is
necessary to understand how this expansion might permanently alter the character of social
154 Katharine Hall, “Covid-19 Info Brief: Social Grant Increases Are an Immediate and Feasible Route to
Protecting Children and Their Families.” (University of Cape Town: Children’s Institute, April 1, 2020),
http://www.ci.uct.ac.za/sites/default/files/image_tool/images/367/94%20COVID-
19%20Info%20Brief%20Social%20grant%20increases%20are%20an%20immediate%20and%20feasible%20ro
ute%20to%20protecting%20children%20and%20their%20families.pdf. 155 Stephen Devereux, “Social Protection Responses to the COVID-19 Lockdown in South Africa,” The
Conversation, April 6, 2020, http://theconversation.com/social-protection-responses-to-the-covid-19-lockdown-
in-south-africa-134817.
61
assistance in South Africa. As an example, one can look to the expansion of South Africa’s
old age pensions in the 1980s and 1990s. Where retirees may have previously depended on
kinship networks for survival, “[by] the 1990s, pensioners were supporting entire households,
including children and grandchildren.”156 It is reasonable to assume that more than doubling
the CSG for an extended period of time will alter social dynamics for many South Africans,
and the ‘income’ will not necessarily benefit men forced into unemployment by the COVID-
19 lockdown. A paper by Granlund and Hochfeld writes that despite the meager levels of the
existing CSG, the grant affords decision-making power to women. Some women reported
husbands or partners “increased feelings of shame on losing their identity as the male
breadwinner and in some cases on the CSG being used as an excuse not to provide parental
money support.”157 This proposal could thus prove disruptive to traditional gendered financial
norms, and recognizes the use of the CSG beyond only child support. While a supplemented
CSG would clearly benefit many at-risk children and caregivers in South Africa, it would
likely be an insufficient proxy for informal employment assistance.
Despite the fact that the CSG age limit and amount have gradually increased over the
past two decades, the CSG has remained relatively small for individual recipients, falling
below South Africa’s food poverty line of 561 rand per person per month.158 Within South
Africa’s work-oriented social protection dialogue, one persistent argument against a
significant CSG increase is highlighted in the 2016 South African Child Gauge. Budlender
writes that although not supported by evidence, some politicians could claim that “a higher
amount could result in a perverse incentive, where the caregiver felt no need to look for
156 Kirsty Button, “South Africa’s Hybrid Care Regime: The Changing and Contested Roles of Individuals,
Families and the State after Apartheid,” Current Sociology 66, no. 4 (July 1, 2018): 602–16,
https://doi.org/10.1177/0011392118765243. 157 Stefan Granlund and Tessa Hochfeld, “‘That Child Support Grant Gives Me Powers’ – Exploring Social and
Relational Aspects of Cash Transfers in South Africa in Times of Livelihood Change,” The Journal of
Development Studies, August 14, 2019, 1–15, https://doi.org/10.1080/00220388.2019.1650170. 158 “National Poverty Lines,” Statistical Release (Statistics South Africa, 2019),
http://www.statssa.gov.za/publications/P03101/P031012019.pdf.
62
work.”159 In terms of political feasibility, some may therefore resist a supplemented CSG as
promoting a culture of dependency, with both caregivers and newly-supported households
expecting and surviving on social grants.
Conclusion:
On April 21, 2020, President Ramaphosa announced a sweeping set of reforms to
South Africa’s social protection system in order to cope with COVID-19. The president
acknowledged that “millions of South Africans in the informal economy and those without
employment are struggling to survive,” highlighting loans and debt restructuring aimed at the
informal sector. In addition, President Ramaphosa announced a COVID-19 Social Relief of
Distress Grant, organized in a way functionally similar to the expanded UIF proposed in this
chapter. The Distress Grant will be paid to all currently unemployed South Africans who do
not benefit from the UIF or other grants.160 While currently set at R350 per person per month
– a level insufficient to replace lost incomes – this is one legitimate strategy for addressing
the needs of South Africa’s informally employed. However, the current plan provides little
information as to how the government will determine eligibility or distribute the grant, with
this chapter suggesting a system similar to that of Namibia. President Ramaphosa also
announced a supplement to the CSG, indicating the use of the grant as a proxy for broader
emergency relief. The proposals in this chapter were written prior to the announcement of
159 Aislinn Delany, Selwyn Jehoma, and Lori Lake, “South African Child Gauge” (University of Cape Town:
Children’s Institute, 2016),
http://www.ci.uct.ac.za/sites/default/files/image_tool/images/367/Child_Gauge/2006/Book_Child_Gauge_2016
_lowres.pdf. 160 “STATEMENT BY PRESIDENT CYRIL RAMAPHOSA ON FURTHER ECONOMIC AND SOCIAL
MEASURES IN RESPONSE THE COVID-19 EPIDEMIC,” SA Coronavirus Online Portal, April 21, 2020,
https://sacoronavirus.co.za/2020/04/21/extraordinary-budget-for-coronavirus-response/.
63
President Ramaphosa’s interventions but are well-aligned with the country’s most current
approach.
This chapter has focused on the particular vulnerabilities of those benefiting from
South Africa’s extensive informal labor market in the midst of the COVID-19 pandemic. One
proposal for assisting this population is to create a new cash transfer specifically for the
informally employed who lose income as a result of the lockdown. This is the most
challenging and logistically infeasible of the proposals, requiring a new programmatic
framework and extensive administrative oversight. The second proposal suggests extending
the UIF to all working-age South Africans who are not formally employed, paying taxes, or
benefiting from other social grants. A broad emergency extension of the UIF would likely
benefit the informally employed most directly but would be expensive and potentially
unpopular amongst recipients. The final proposal considered a supplemented CSG, which
would be simple and cost-effective but is unlikely to fully relieve the strain placed on
informal laborers. While protecting the informal economy must be an aspect of South
Africa’s COVID-19 response, each intervention should be considered within the context of
the proposal’s broader implications and the government’s limited fiscal capacity. South
Africa has already made significant strides towards benefiting informal laborers in the midst
of COVID-19, but these proposals highlight administrative and economic shortcomings of the
current plan as well as a potential way forward.
64
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Chapter 3: The Immunocompromised Poor
Sydney Johnson
Abstract:
Across the globe, nations are adapting their social protection systems in order to
provide support to citizens during the coronavirus (COVID-19) pandemic. While the previous
two chapters propose social protection reforms intended to help South Africa combat the
economic effects of the pandemic, which have proven to be more dire than the public health
effects over the course of our research, this chapter considers measures to help the nation
circumvent the potential public health consequences of mass transmission.
I will examine the advantages, disadvantages, and feasibility of interventions targeting
the immunocompromised poor in South Africa. In this context, the term
“immunocompromised poor” refers to the many South Africans living with chronic illnesses
and in poverty that render them especially vulnerable to COVID-19. This is a large
population; chronic illness prevalence is extremely high in South Africa because of dual HIV
and tuberculosis epidemics, and it disproportionately affects the poor. Targeting this
population is important for multiple reasons, all boiling down to slowing the spread of the
virus: (1) we want to enable immunocompromised individuals to adhere to strict social
distancing protocols; and (2) we want them to remain healthy and medicated, if they are, so
that they are better able to fight off a potential infection.
One proposal explored in this chapter is the creation of a Chronic Illness Grant (CIG)
for which the immunocompromised can be registered, regardless of whether or not they are
currently on treatment for their illness or employed. An alternative intervention is to support
low-income, chronically ill persons who are not treated nor virally suppressed with temporary
coverage from the Disability Grant (DG), under which some individuals with underlying
medical conditions are currently covered.
Consideration of these proposals exposes some complicating factors regarding
targeting the immunocompromised poor with social protection interventions, despite how
compelling it might seem to do so, in theory. First, not all people who are both chronically ill
and poor are disabled, so they truly don’t need coverage via the DG. Additionally, not all
people who are chronically ill are high-risk for severe illness from COVID-19 because they
are stably medicated or have managed to mitigate the impact of their immunosuppression.
The political feasibility of targeting the immunocompromised poor is also quite low, as
policymakers might fear that they are enabling the chronically ill to take further advantage of
70
the DG, that a grant specifically for the chronically ill could have perverse incentives or cause
dependency, and that a decision to shield the chronically ill now would be unpopular, given
that, under normal circumstances, it implies that they are more deserving of coverage than
other low-income individuals. Administratively, enrollment of millions of new grant
applicants would be difficult to manage considering the limited capacity of SASSA and
medical officials, but because of the targeted nature of these interventions, they would be
significantly easier to implement than the other proposals presented which aim to cover much
broader populations.
Overall, the pandemic has put a condemning spotlight on South Africa’s social
protection system. The lack of support for unemployed or informally-employed, working-
aged South Africans has forced them to take advantage of the DG as a means of poverty
alleviation, even if they are not truly disabled. This, in turn, has driven policymakers to
continue to restrict access to the DG and to dismiss proposals for interventions extending
support to the immunocompromised poor, lest they encourage dependency. Now, in the midst
of a public health crisis and a nationwide lockdown, there are high-risk individuals without
social protection who will struggle to follow social distancing protocols or maintain treatment
regimens because of financial strain. Regardless of whether or not South Africa decides to
extend coverage to the immunocompromised poor currently trying to get by without it, it
should not overlook the glaring holes in its safety net that threaten the integrity of the entire
system.
Introduction:
President Cyril Ramaphosa’s first address to the South African people outlining the
measures that the nation would take in response to COVID-19 stressed that viral transmission
was the country’s greatest concern. “Our fundamental task at this moment is to contain the
spread of the disease,” he stated, followed by his premonitions that “a rapid rise in infections
will stretch our health services beyond what we can manage and many people will not be able
to access the care they need.”161 Thus, he declared the nationwide lockdown that commenced
161 “Statement by President Cyril Ramaphosa on Escalation of Measures to Combat the Covid-19 Epidemic,
Union Buildings, Tshwane | The Presidency.”
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on March 26, encouraging all people to practice good hygiene and to follow social distancing
protocols.
While Ramaphosa emphasized the importance of containing the outbreak due to
South Africa’s “large number of people with suppressed immunity because of HIV and TB,
and high levels of poverty and malnutrition,” he made no indication that COVID-19-specific
social protection for these individuals was on the way.162 Thus, I began my research with the
intention of suggesting ways that South African policymakers could carry out the President’s
initial objective—to contain the spread of the disease, especially amongst the
immunocompromised poor—in order to prevent overwhelming medical facilities, which
would have devastating public health effects. Thus, in this section of the paper, I will be
exploring ways that South Africa’s social protection system can extend coverage to those
most likely to become severely ill from COVID-19 in the hopes that protecting this
population can save lives. These policies are intended to shield one subset of what scholars
consider the “deserving” poor from the negative externalities of a pandemic.163
Before I present my policy proposals, I will elaborate upon the characteristics of
South Africa’s population and health care infrastructure that makes the country particularly
vulnerable to devastation. First, many South Africans are immunocompromised. The country
currently has the largest HIV epidemic and the sixth largest TB epidemic in the world, with
an approximated 60% of people living with HIV (PLHIV) also infected with TB.164
According to the Centers for Disease Control and Prevention (CDC), individuals living with
underlying medical conditions such as HIV or TB at any age are among those considered
162 “Statement by President Cyril Ramaphosa on Escalation of Measures to Combat the Covid-19 Epidemic,
Union Buildings, Tshwane | The Presidency.” 163 Michael B. Katz, The Undeserving Poor : America’s Enduring Confrontation with Poverty, Second edition.
(Oxford: Oxford University Press, 2013). 164 “HIV and AIDS in South Africa,” Avert, July 21, 2015, https://www.avert.org/professionals/hiv-around-
world/sub-saharan-africa/south-africa.
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high-risk for severe illness from COVID-19.165 Belonging to a high-risk group means having
an increased likelihood of developing medical complications from the virus. So far, research
has shown that a significant majority of patients hospitalized due to COVID-19 “had one or
more underlying conditions, the most common being obesity, hypertension, chronic lung
disease, diabetes mellitus, and cardiovascular disease.”166 Evidently, nations with inadequate
health care infrastructure cannot afford for high rates of transmission of COVID-19 to occur
amongst their most vulnerable populations. Not even countries with high standards of living
are exempt from possible overcrowding in hospitals. According to the Washington Post,
nearly half of the United States’ adult population “live where virus patients could overwhelm
the supply of mechanical ventilators.”167
Thus, the second reason that South Africa is particularly vulnerable to COVID-19-
related disaster: poor healthcare infrastructure. 84% of the population uses an inefficient
public health system due to a lack of medical insurance and consequently relies upon
facilities with improper infection control and limited drug availability for their health care.168
So, to prevent incapacitating an already overburdened system of local clinics and hospitals, it
is imperative that South Africa focuses its preventive efforts in areas where its most
vulnerable populations are concentrated and where there is higher transmissibility of the
virus. These areas, known as townships, are low-income settings characterized by larger
household sizes, inadequate sanitation, and higher rates of disability and chronic illness
165 CDC, “Coronavirus Disease 2019 (COVID-19),” Centers for Disease Control and Prevention, February 11,
2020, https://www.cdc.gov/coronavirus/2019-ncov//groups-at-higher-risk.html. 166 Shikha Garg, “Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed
Coronavirus Disease 2019 — COVID-NET, 14 States, March 1–30, 2020,” MMWR. Morbidity and Mortality
Weekly Report 69 (2020), https://doi.org/10.15585/mmwr.mm6915e3. 167 Amy Brittain et al., “How a Surge of Coronavirus Patients Could Stretch Hospital Resources in Your Area,”
Washington Post, accessed April 16, 2020,
https://www.washingtonpost.com/graphics/2020/investigations/coronavirus-hospitals-data/. 168 Mike Cohen, “Analysis | How South Africa Plans to Fix an Ailing Health System,” Washington Post,
accessed April 8, 2020, https://www.washingtonpost.com/business/how-south-africa-plans-to-fix-an-ailing-
health-system/2019/08/14/7a8b0fae-be6a-11e9-a8b0-7ed8a0d5dc5d_story.html.
73
among residents.169 Currently, in order to support those living in impoverished settlements
like these townships, the South African Social Security Agency (SASSA) distributes different
grants to those who are eligible. So, in this section of the paper, I will present policy
interventions intended to protect South Africa’s immunocompromised poor from severe
illness through expansions and transformations of South Africa’s already existing social
protection system.
As mentioned in the Introduction chapter of this paper, South Africa’s history of
battling HIV and TB has left the nation endowed with a far-reaching network of disease-
fighting infrastructure and with the experience necessary to conduct mass testing. 67 Mobile
testing units have been designated for screening, swabbing, and testing residents in high-risk
South African communities, equipped with repurposed TB-testing machines.170 However, I
believe that South Africa needs to be doing more than just testing; officials need to ensure
that high-risk individuals are able to take the proper precautions to limit themselves from
exposure to the virus (by social distancing and accessing COVID-19-related news) and
maintain their current medical treatment regimens. This is especially important now that
President Ramaphosa has announced the gradual lifting of the nation-wide lockdown
beginning May 1. The eldery and those with underlying conditions, told that they “must
remain at home and take additional precautions to isolate themselves” unlike others, will now
have neighbors or household members going back out into the community, increasing their
chances of infection.171 For these reasons, I believe that the all immunocompromised
169 Maysoon Dahab et al., “COVID-19 Control in Low-Income Settings and Displaced Populations: What Can
Realistically Be Done?,” LSHTM, March 20, 2020, https://www.lshtm.ac.uk/newsevents/news/2020/covid-19-
control-low-income-settings-and-displaced-populations-what-can. 170 Associated Press, “South Africa’s History of TB, HIV Prepares Country for Coronavirus Testing,” New York
Post (blog), April 6, 2020, https://nypost.com/2020/04/06/south-africas-tb-hiv-history-prepares-it-for-virus-
testing/. 171 “Statement by President Cyril Ramaphosa on Escalation of Measures to Combat the Covid-19 Epidemic,
Union Buildings, Tshwane | The Presidency.”
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individuals who pass the DG means test and can prove their immunocompromised status to a
medical official and SASSA officer should be registered for either the DG or a CIG.
There is real evidence that individuals with higher incomes are better able to protect
themselves from viral exposure. The immunocompromised poor are encouraged to take extra
precautions to avoid infection, like limiting visitors and disinfecting frequently-touched
surfaces.172 However, some of these precautions seem to be a luxury of those who are more
affluent. Those who are low-income cannot afford to buy subscriptions to grocery delivery
services or not take public transportation, so as long as these socioeconomic inequalities are
exacerbated by the pandemic, the poor are more likely to bear the brunt of the devastation.173
It’s no wonder that so many countries have been extending money to their low-income
populations, if not to everyone, for the sake of public health. A 2016 CDC study found that
administration of a UBI in Kenya between 2011 and 2013 improved households’ wellbeing
and food security, and it is critical that these aspects of one’s livelihood are protected during
a health crisis, especially for those with underlying medical conditions.174 However, as will
be discussed further in the Conclusion chapter of this paper, the implementation of a UBI is
administratively impossible in South Africa due to a lack of an organized and complete
registry of citizens. Thus, South Africa will have to rely on its grant system to give the
immunocompromised poor the means to adequately protect themselves from COVID-19.
Grant payments could contribute toward one’s ability to maintain good hygiene, stay
connected with doctors, adhere to treatment regimens, and distance oneself from others.
Additionally, because the proposals are so narrowly-targeted, they can be packaged with
other interventions.
172 Levine, “Protect Yourself If You’re at High Risk for Coronavirus.” 173 Laughlin, “Money Can Buy Some Protection from Coronavirus. But the Poor Can’t Afford It, Leaving Them
More Vulnerable.” 174 “The Impact of Unconditional Cash Transfers in Kenya | The Abdul Latif Jameel Poverty Action Lab.”
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Introducing the Chronic Illness Grant:
The South African government might consider introducing a CIG designated for low-
income persons with chronic illnesses. In addition to protecting this vulnerable population
during the pandemic, a CIG has the potential to become a permanent part of the social
protection system that can support poor, chronically ill South Africans whether they are
immunosuppressed, treatment-dependent, or able-bodied. A CIG could also create space for
meaningful reforms to the DG that could benefit people with disabilities (PWDs), and it
could reduce the incentive for chronically ill individuals to trade off health or treatment
adherence for DG eligibility. While creating a grant to support a currently unsupported
population has more political feasibility during a pandemic due to the potential nation-wide
economic consequences of widespread severe illness, the likelihood that policymakers will
consider establishing a grant like a CIG in South Africa remains relatively low. This is the
result of a popular discourse implying that grant receipt causes dependency, a hesitancy to
target one able-bodied population over another, and the fact that there is limited
administrative capacity available to create and maintain a new grant. All of these points will
be discussed further within the following subsections.
Background:
In 2006, the Department of Health (DOH) and the Department of Social Development
(DSD) came together to pilot a disability assessment tool intended to determine applicants’
eligibility for the DG and the 2003 Policy of Free Health Care at Hospitals for People with
Disabilities (FHC). It was called the Harmonised Assessment Tool (HAT), and it defined
disability as “a moderate to severe limitation in a person’s ability to function or ability to
perform daily activities as a result of physical, sensory, communication, intellectual or mental
impairment.” No longer solely reliant upon strict medical guidelines, the HAT called for
Activity Limitation Assessments to identify applicants whose abilities to function and
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perform activities had been impaired. Kelly explains, “This focus was expected to ensure that
only genuinely disabled people received the grant and also make the assessment process more
sensitive to hidden disabilities than had not been possible through medical assessment
alone.”175 Thus, the introduction of the HAT was both an inclusionary and exclusionary
measure.
Those who were most obviously excluded from DG coverage because of the HAT’s
new definition of disability were the chronically ill. Recognizing that the chronically ill
would still need coverage, the Human Science Research Council (HSRC), commissioned by
the DSD, proposed “the introduction of the HAT alongside a Chronic Illness Grant (CIG) for
people with chronic illnesses not eligible for the DG.”176
By then, the CIG had already been drafted by the South African National AIDS
Council (SANAC) (in the National Strategic Plan on HIV/AIDS) and then approved by
cabinet in 2007. AIDS activists organizations embraced the idea of a CIG, and the DSD
initially supported the proposal, as well. However, the policy was rejected at the 2007 ANC
Policy Conference because of concerns that grants creating dependency. The ANC felt that
the government would be better off developing anti-poverty policy, instead. Thus, they
intended to move ahead with the implementation of the HAT that would exclude the
chronically ill from grant access and instead offer the immunocompromised poor food
vouchers under the advising of the DOH and the Integrated Food and Nutrition Task Team.177
“Dependency discourse” plagued the HAT and CIG. The Social Development
Portfolio Committee believed that “unemployment and poverty were not the exclusive
problems of the DSD” and that support for the chronically ill was better addressed by
“employer education programmes and job creation strategies rather than social grants.”
175 Kelly. 176 Kelly. 177 Kelly.
77
However, the exclusion of the chronically ill from DG access did not matter, in the end. The
DOH admitted that it did not have the capacity to conduct the HAT Activity Limitations
assessments. Since then, little progress has been made toward transforming the DG because
“the healthcare system is unlikely to have the capacity to carry out Activity Limitations
assessments for some time.”178 Both the proposals for the HAT and a CIG were shelved.
With consideration of the issues plaguing DG administration (discussed in detail in a
future section, titled “Expanding the Disability Grant”) and the notion that reform of the grant
could benefit both people with disabilities (PWDs) and people living chronic illnesses in the
future, I propose that SASSA enrolls high-risk, working-aged individuals currently excluded
from DG coverage as beneficiaries of a new grant designated for the immunocompromised
poor so that the DSD can revisit proposals for the CIG and, potentially, the HAT.
Introducing the Chronic Illness Grant:
As health professionals enter townships with high probabilities of becoming hot spots
for COVID-19 transmission to screen residents and identify high-risk individuals that should
be tested for the virus, administrative steps should be taken to enroll said individuals as grant
beneficiaries in order to help them protect themselves from severe illness. Each mobile unit
sent into vulnerable communities has two nurses, one for collecting clinical samples for
testing and one for recording the patient’s identifying details, medical history, and recent
contacts. I propose that a SASSA officer, too, is present during these processes so that they
can oversee the enrollment of low-income, chronically ill South Africans into a CIG.
Because South Africa has a high rate of unemployment and poor,
immunocompromised South Africans face workforce discrimination for low-level
positions,179 even the medicated immunocompromised poor require social protection. Studies
178 Kelly. 179 Sprague, Simon, and Sprague, “Employment Discrimination and HIV Stigma.”
78
have shown that the ARV drug roll out in 2004 improved the health of PLHIV in such a way
that they lost their DG eligibility. While PLHIV tended not to stop medicating completely in
order to retain their benefits, some managed to “lower the CD4 count without stopping ARVs
completely” because they desperately needed the financial support. De Paoli et al. find that
“the disability grants played a crucial role in maintaining their financial, emotional and
physical well-being.”180 Evidently, grant money is vital to a chronically-ill individual’s
ability to support themself.
Thus, the able-bodied, immunocompromised poor should be enrolled as beneficiaries
for a new grant, similar to the DG but specified for the chronically ill. The enrollment process
is meant to absorb those who are high-risk for severe illness from COVID-19 but excluded
from DG access; those who are chronically ill but already covered by the DG will not be
doubly enrolled.
This measure would prove to be more helpful than DG expansion in the long-run. If
we simply choose to expand the DG within this greater period of policymakers’ attempts to
limit DG access for the sake of reduced spending, these chronically-ill beneficiaries are going
to lose their benefits once their temporary grant period ends. This is in spite of research
showing that the restored health of PLHIV actually increases the unemployment rate since
many of these individuals were still unable to secure employment, and that they still require
financial support because of their sickness and poverty.181 Recent calls made for the
implementation of a CIG advocate for the provisioning of “life-long income support for those
with chronic illness including HIV/AIDs” without excluding employed patients.182 A CIG
that supports the chronically ill in this way can encourage treatment adherence since the
180 de Paoli, Mills, and Grønningsæter, “The ARV Roll out and the Disability Grant.” 181 Celeste Coetzee and Nicoli Nattrass, “Living on AIDS Treatment: A Socio-Economic Profile of Africans
Receiving Antiretroviral Therapy in Khayelitsha, Cape Town” (University of Cape Town, 2004). 182 Veloshnee Govender et al., “Disability Grant: A Precarious Lifeline for HIV/AIDS Patients in South Africa,”
BMC Health Services Research 15, no. 1 (June 9, 2015): 227, https://doi.org/10.1186/s12913-015-0870-8.
79
immunocompromised poor who are medicated will still receive benefits, and it will not
discourage recipients from looking for work since it will not prejudice employed patients. In
the future, the chronically ill who are currently taking advantage of the DG will be
incentivized to enroll, instead, for the CIG because it will offer them lifelong support versus
the temporary grants (with reassessments occuring after 12 months of enrollment) that they
are likely receiving at the moment.
Beginning to offer support for the chronically ill through a CIG would decrease the
number of DG beneficiaries, which policymakers have been attempting to do for years. It
would also create an opportunity for DG reform, as the grant can more clearly and narrowly
define disability in terms that are less medically-oriented and have more of a focus on
functionality. Thus, the DSD can revisit proposals for the HAT in assessing disability.
Implementation of a tool like the HAT and its Activity Limitation assessments would make
those with mental disabilities more likely to be granted eligibility for the DG because of the
functionality (versus medical) emphasis. Thus, DG exclusion errors would be reduced, and
those excluded because of the restoration of their health would still be covered in another
way (by the CIG).
Additionally, there is potential for CIG transformations in the future. For now, while
South Africa focuses its efforts on battling the pandemic, the CIG can exist solely as a grant
paying out similar amounts to the DG. This way, high-risk individuals excluded from DG
coverage won't be incentivized to sacrifice their health (by interrupting medical treatment or
disabling themselves) for increased payments from the DG. However, in the future, the DSD
will retain the flexibility to transform the CIG so that it pays less to those able-bodied enough
to have the capability to achieve employment (to reduce government spending) while also
test-driving targeted job creation schemes, employment guarantee schemes, or the
80
provisioning of “tax incentives for firms to provide preferential employment” for CIG
recipients.183
Unlike the proposal to simply expand the DG, introducing a CIG is a more permanent
measure that can be used to South Africa’s advantage in the case of a future health crisis. As
aforementioned, it will allow the DSD flexibility in creating support avenues for poor people
with chronic illnesses attempting to treat themselves and enter the workforce. The DG has
been used unintentionally as a means of alleviating poverty in the last two decades because of
a lack of support for certain vulnerable populations.184 In order to take the first steps toward
moving away from this while also reforming the DG for PWDs and ensuring a high-risk
group does not fall through the holes in the safety net, there should be a CIG in place for the
immunocompromised poor who have experienced health restorations.
Political, Economic, and Administrative Feasibility:
I estimate the cost of a CIG to be approximately R8.4 billion per month for the next 6
months (R50.4B in total), barring administrative costs. This is based on a calculation
suggesting that there will be 4.5 million beneficiaries enrolled over time, paid R1,860 per
month. During all instances of rounding, estimates were rounded up to leave room for those
with other chronic illnesses, such as hypertension and diabetes, even though these tend to be
concentrated amongst groups with higher socioeconomic statuses in South Africa.185
Additionally, the estimates should be high because I did not account for the fact that illnesses
are also likely to be more prevalent amongst the elderly, who are only eligible for the Old
Age Grant. There are also likely to be instances of overlap between those with HIV and TB
due to the prevalence of comorbidities amongst low-income populations.
183 Nicoli Nattrass, “Disability and Welfare in South Africa’s Era of Unemployment and AIDS,” Working Paper
(University of Cape Town, 2006), https://open.uct.ac.za/handle/11427/19315. 184 Nattrass. 185 Mutyambizi et al., “Lifestyle and Socio-Economic Inequalities in Diabetes Prevalence in South Africa.”
81
There are 7.7 million PLHIV in South Africa, and those in the bottom 40% of
socioeconomic standing bear 56% of the burden of the disease (4,312,000).186 Of the 235,652
active TB cases, 65% of them are found within the bottom 40% of the population (153,174).
These two numbers sum to 4,465,174, which is rounded up to 4.5 million beneficiaries (to
account for the other, less prevalent chronic illnesses) paid R1,860 per month.187 This
indicates that a CIG would pay out R8,370,000,000 monthly, rounded up to R8.4 billion.
Relative to the costs of other proposals, including Ramaphosa’s planned expansion of the
CSG (costing R35 billion on average over the next six months, monthly), this is an affordable
measure. It can be packaged with other interventions in order to help South Africa best
respond to the pandemic.
We must also consider the administrative and political feasibility of implementation,
though. DG exclusion errors reflect the exclusion of different populations. They shed light on
the arbitrary nature of the eligibility assessment process that PWDs must endure, and they
also absorb a portion of the immunocompromised poor who are often ruled ineligible for
grant access because of restored health or access to treatment. Thus, enrolling medicated yet
chronically ill individuals into a separate grant (a CIG) than those simply excluded from DG
access due to administrative barriers would require health professionals in charge of the
enrollment process to have to distinguish between the two groups. So, administratively, this
proposal is more tedious for SASSA to implement than merely expanding the DG. However,
screenings and the collection of identifying information from chronically-ill individuals can
happen in the same way they would if all beneficiaries were being enrolled in the DG (from
within the mobile units), so the increase in difficulty is marginal. Otherwise, the distribution
of the grant can mirror exactly that of the DG.
186 Ataguba, Akazili, and McIntyre, “Socioeconomic-Related Health Inequality in South Africa.” 187 The data used to perform these calculations is from 2018.
82
However, introducing a CIG in South Africa is clearly more than just an expansion of
the DG; it’s the beginning of a transformation. I’m hopeful that the threat of the COVID-19
pandemic will compel the DSD to reform the DG in such a radical, positive way. Though, it
is not unlikely that they will face administrative hurdles from other pandemic-related
occurrences and interventions that hinder how efficiently they can outline and establish a new
grant entirely, as other vulnerable populations also require social protection. And now that we
have received information about South Africa’s confirmed COVID-19 interventions, it is
even less likely that the government will feel compelled (or able) to implement a more
narrowly-targeted measure that necessitates the creation of a new grant.
Across the world, the pandemic has been shown to increase the political feasibility for
liberal social protection measures. 50 countries have implemented a cumulative total of 102
new cash transfer initiatives specifically in response to COVID-19, and “nearly 622 million
beneficiaries are specifically supported via COVID-related introductions, expansions, and
adaptations of social assistance programs.”188 This has proven to be the case in South Africa,
as well; the state has decided to implement a special COVID-19 Social Relief of Distress
Grant to support unemployed, working-aged South Africans who might have no history of
formal employment. This population has historically been barred from social protection, but
in an effort to mitigate the economic consequences of the pandemic, the ANC has extended
them coverage. If South Africa decides to refocus its objectives in an attempt to avert
possible public health detriments, the political feasibility of extending coverage to the
nation’s unsupported chronically ill is likely higher now than it has ever been.
Additionally, note the following claim from Kelly: “The government has struggled to
accurately target disabled people for receipt of DGs because the chronically ill and the able-
188 Gentilini et al., “Social Protection and Jobs Responses to COVID-19: A Real-Time Review of Country
Measures.”
83
bodied unemployed sitting on the margins of the social security system have also attempted
to access DGs, sometimes with the help of sympathetic social workers, doctors and
government officials.” Policymakers have attempted to place limitations on DG access in
order to exclude certain groups from receiving benefits. However, the focus on exclusion
“has distracted policymakers and legislators from developing a disability grant system that
promotes the inclusion and development of disabled people in society,” and I believe that
implementation of a CIG to support the low-income chronically ill and the HAT to better
assess disability in terms of functioning will benefit both PWDs and the
immunocompromised poor.189 Since policymakers are already attempting to restrict the
chronically ill from accessing the DG, a proposal for the beginnings of a DG transformation
in the form of a CIG could be politically palatable.
As far as future reforms of the CIG go, which will inevitably have to happen once the
pandemic ends, a reduced payment to support the chronically ill on treatment would be more
politically feasible and would reduce government spending. However, in order to
disincentivize the immunocompromised poor from disabling themselves to instead access the
DG, the CIG can be supplemented with job creation schemes to support these individuals.
Considering the dependency discourse that is so common amongst policymakers, a work
program to replace some of the value of the grant would be politically popular. Though,
decisions to implement programs like these or to create tax incentives for firms to hire the
immunocompromised poor are “expensive and administratively complex” and, in short,
unfair to those who are poor and unemployed yet never had access to these benefits. This
could revitalize the perverse incentive to disable or disease oneself.190
189 Kelly, Regulating Access to the Disability Grant in South Africa, 1990-2013. 190 Nattrass, “Disability and Welfare in South Africa’s Era of Unemployment and AIDS.”
84
Additionally, it is doubtful that the DOH is more likely to have the capacity to support
implementation of the HAT and Activity Limitation assessments now than it did almost two
decades ago, when the idea had to be scrapped because of their lack of readiness. Kelly
explains, “Although the DSD has made attempts to move away from pure medical assessment
of grants, the complexities and costs of assessing activity limitations and their relation to
social, economic context and the physical environment, are too high for the current healthcare
or social security system to manage effectively.”191 Administratively, then, implementation of
the HAT presents challenges. However, that does not mean that the CIG can not be
introduced in the meantime, as all that currently necessitates is the creation of a new grant
much like the DG but made specifically for the immunocompromised poor, regardless of
their assessed ability. The transitioning of other chronically ill beneficiaries receiving the DG
to the CIG can occur once the pandemic has ended and there is less immediate stress on
SASSA and the DSD.
Shortcomings:
Similar to what has been shown to occur to the DG, it is likely that, especially during
this pandemic, income from a CIG would be shared by the household. This could lead to
extortion or abuse of the CIG recipient, especially if they are perceived as just as able-bodied
as those abusing them.192 The intention is that the CIG recipient uses the grant money to
protect themselves from exposure to COVID-19. They should establish technological links to
doctors, purchase medication in bulk, and social distance as best they can. However, if the
grant is used for other things like supporting the household and supplementing lost income,
the medical care of these individuals could be interrupted and their immune systems could
suffer, further putting them at risk for severe illness.
191 Kelly, Regulating Access to the Disability Grant in South Africa, 1990-2013. 192 Kelly, “The Influence of Disability-Related Cash Transfers on Family Practices in South Africa.”
85
In the future, if the CIG becomes associated with the idea of being a reduced
disability grant, it could incentivize low-income people to disable themselves in order to
become eligible for the DG, instead. If we begin to tier CIG receipt and differentiate between
those who are treated and those who are not, giving more to those who are not because of
their inability to access work, this might disincentivize patients from medicating themselves.
Although studies have shown that this has occurred infrequently in the case of PLHIV with
restored health losing DG eligibility, the government’s inaction regarding offering permanent
and substantial support to unemployed, working-aged people will likely drive unsupported
populations to desperation as the unemployment rate rises. While targeting the “deserving
poor” is cheaper, it invites exploitation and abuse of social protection programs by those
ineligible for benefits.
Expanding the Disability Grant:
Should the political and administrative feasibility of creating a Chronic Illness Grant
prove to be too low, South African policymakers should consider expanding the DG by
enrolling more beneficiaries to receive temporary (6-month) coverage. This expansion would
be a consequence of added leniency to the eligibility assessment that has historically barred
some applicants from grant access.193 If we take containing the spread of disease to be our
main objective, extending social protection to South Africa’s immunocompromised poor is
imperative. Allowing for easier enrollment would allow a larger portion of the country’s
chronically ill to follow social distancing protocols and maintain their treatment regimens due
to DG payments. Expansion of an already-established grant has the benefit of being
administratively simple, though, as is the case with the CIG, it would require the processing
193 Mitra, “Disability Cash Transfers in the Context of Poverty and Unemployment.”
86
of millions of applications. However, the government’s recent track record of restricting
access to the grant (due to dependency discourse and a belief that the chronically ill have
been taking advantage of the DG) and the consequent decline of DG recipients suggests that
the inclusion errors that will be impossible to avoid during DG expansion will be politically
unpopular. All of these points will be explored in greater detail in the following subsections.
Background:
The DG is a means-tested allowance granted to South Africans between 18 and 59
years of age that is a part of the country’s rather generous social protections system. It is the
only non-contributory cash transfer available to working-aged individuals, and its coverage
extends to those with at least one disability or chronic illness that renders the beneficiary
unable to "(a) obtain the means needed to enable him or her to provide for his or her own
maintenance; or (b) be gainfully employed,” either permanently or temporarily.194 A
temporary grant is paid for between six and twelve months, as one must demonstrate not
being able to work for at least six months to a Department of Health (DOH) or SASSA
doctor.
The benefit was first introduced in 1937 as a means of supporting poor white South
Africans and has since undergone many expansions and reductions, particularly since the end
of Apartheid in the 1990s. Recent scholarly analysis of the DG posits that the grant
underwent a phase of extending access between 1990 and 2000 due to end-of-Apartheid
social rights discourse, a second phase involving increased generosity as the DG grew in size
between 2001 and 2007, and a final phase featuring new limitations placed on grant access
and a consequent decrease in the number of grant recipients from 2007 onwards.195
194 Gabrielle Kelly, Regulating Access to the Disability Grant in South Africa, 1990-2013, 2014. 195 Kelly.
87
Today, there are about 1 million South Africans receiving the DG, valued at
R1,860.196 However, the grant is littered with administrative barriers to access, while
featuring little inclusion error. Firstly, merely being diagnosed with a condition such as
hypertension, diabetes, or HIV does not mean you will automatically qualify for the grant, as
you must demonstrate to a doctor that you are not healthy nor stable, that you’re not able to
move around, or that you cannot carry out daily tasks.197 But health professionals’
determinations of who is or is not eligible for the DG are arbitrary. These decisions are
influenced by personal culture, values, and knowledge, and doctors tend not to offer the grant
to those whose disabilities are not visible, permanent, recognized as a medical illness, or
perceived as externally caused, which excludes those with mental illnesses from eligibility.198
Clearly, the DG’s exclusion errors are far-reaching, and despite debate from policymakers
who have pioneered the effort to restrict grant access, its “inclusion errors are relatively
limited.”199 Policymakers’ belief that the chronically ill have taken advantage of the DG
might be the result of a phenomenon in which beneficiaries “perform disability” in front of
medical officers in order to access the grant.200
My proposal for expanding the DG in South Africa is intended to address the
complexity of the application process and eligibility criteria that act as barriers to grant
access. It is imperative that all high-risk individuals are supported in the midst of this public
196 “Social Grants - Coronavirus COVID-19 | South African Government,” accessed April 15, 2020,
https://www.gov.za/coronavirus/socialgrants. 197 Gabrielle Kelly, “Frequently Asked Questions about Social Grants,” GroundUp News, May 15, 2017,
https://www.groundup.org.za/article/frequently-asked-questions-about-social-grants/. 198 Gabrielle Kelly, Hard and Soft Medicine: Doctors’ Framing and Application of the Disability Category in
Their Assessments of Grant Claimants’ Fitness to Work in South Africa, 2016,
https://doi.org/10.13140/RG.2.1.4569.3686; Ashley Mcallister, “Mental Illnesses Are Not an ‘Ideal Type’ of
Disability for Disability Income Support: Perceptions of Policymakers in Australia and Canada,” Scandinavian
Journal of Public Health, January 11, 2019, 1403494818816903, https://doi.org/10.1177/1403494818816903. 199 Sophie Mitra, “Disability Cash Transfers in the Context of Poverty and Unemployment: The Case of South
Africa,” World Development 38, no. 12 (December 1, 2010): 1692–1709,
https://doi.org/10.1016/j.worlddev.2010.06.014. 200 Kelly, “(PDF) ‘We Want Another Doctor!’ Citizen Agency and Contested Notions of Disability in Social
Assistance Applications in South Africa.”
88
health crisis if we are to contain the spread of infection. Therefore, the DG should expand its
coverage to those excluded from grant receipt by temporarily increasing the leniency of the
DG eligibility assessment process and registering high-risk individuals while swapping them
for COVID-19 in low-income townships.
Expanding the Disability Grant:
I believe that the DG should expand its coverage to chronically-ill South Africans
who are barred from grant access due to administrative issues despite their acute
vulnerability. The intention is to support those who are not virally suppressed or on treatment
and yet are still not receiving the DG, likely due to the government’s attempts to decrease
beneficiaries and the arbitrary and confusing application processes. This should be done in
order to ensure that all particularly high-risk individuals are able to take additional
precautions to avoid COVID-19 infection and to supplement their household incomes, as they
have likely decreased because of the national lockdown.
Increasing the number of beneficiaries for the grant necessitates increased leniency in
the DG eligibility assessment process. I propose that, as health professionals enter townships
with high probabilities of becoming hot spots for COVID-19 transmission to identify high-
risk individuals that should be tested for the virus, administrative steps should be taken to
enroll said individuals as DG beneficiaries in order to help them protect themselves from
severe illness. Each mobile unit sent into vulnerable communities has two nurses, one for
collecting clinical samples for testing and one for recording the patient’s identifying details,
medical history, and recent contacts. I propose that a SASSA officer, too, is present during
these processes so that they can oversee the enrollment of high-risk individuals.
An increase in income for high-risk persons will better allow them to protect
themselves from exposure to the virus while also helping them to access medical treatments.
The CDC recommends that individuals with HIV, of which South Africa experiences high
89
rates, ensure that they have a 30-day supply of medication on hand and establish a
telemedicine link to their care provider, or are at least able to communicate with them via
phone.201 In South Africa, nine-in-ten adults own a mobile device, with 51% of this
population owning a smartphone.202 A smartphone can give individuals access to the data-
free website that the nation has already established for the purpose of sharing COVID-19
updates, and it would be beneficial for those at risk for severe illness to be able to access this
information so they can learn how best to protect themselves. Financially supporting people
living with chronic illnesses can help them stay in touch with doctors (especially since
physical visits to care facilities are being limited), buy medications in bulk, and access
COVID-19-related news. For those who are not currently on treatment, it will give them the
means to access medications and doctors who can advise them. The CDC emphasizes the
importance of immunocompromised persons taking care of their immune systems as best they
can during the pandemic, so those who have gone without treatment need to ensure that they
begin to receive it.
Additionally, supporting the immunocompromised poor will have community-wide
benefits. Studies have shown that “disability grant income is shared within households and
the contribution of a stable income provides opportunities for disabled people to exercise
agency, be seen as valuable household members and secure care and support from other
household members.”203 During these weeks when high-risk individuals cannot fully rely on
medical professionals to support them, it is imperative that those living with or near high-risk
persons can be relied upon to help carry out tasks that high-risk individuals are unable to
201 CDC, “Coronavirus Disease 2019 (COVID-19),” Centers for Disease Control and Prevention, February 11,
2020, https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html. 202 Laura Silver and Courtney Johnson, “Basic Mobile Phones More Common than Smartphones in Sub-Saharan
Africa,” Pew Research Center’s Global Attitudes Project (blog), October 9, 2018,
https://www.pewresearch.org/global/2018/10/09/majorities-in-sub-saharan-africa-own-mobile-phones-but-
smartphone-adoption-is-modest/. 203 Gabrielle Kelly, “The Influence of Disability-Related Cash Transfers on Family Practices in South Africa,”
June 1, 2018.
90
perform safely because of their high-risk status or their illness or disability. Also, DG
coverage can disincentivize those living with high-risk individuals from defying social
distancing practices, as it will serve to supplement their losses of income during the
lockdown.
Finally, financially supporting high-risk populations can help protect all low-income
South Africans from the negative externalities of the COVID-19 pandemic. Research shows
that comorbidities are prevalent in low-income settings, in agreement with the idea that
economic stability, among other factors known altogether as the social determinants of
health, impacts health outcomes.204 But the health of these residents is not just dependent on
whether or not they, themselves, become exposed to COVID-19. Historically, a nation’s
poorest people bear the brunt of not only public health crises but also their harmful side
effects. If the public health system in South Africa were to become overwhelmed with
COVID-19 cases, as seen in other nations, those using the facilities to treat other chronic
conditions might have their care interrupted.205 Alternatively, an overload of patients infected
with COVID-19 in public health facilities could expose the immunocompromised poor to the
virus and put them at risk of severe illness or death. This is especially true for chronically ill
individuals who are not on treatment nor virally suppressed. Because of the high prevalence
of HIV and TB amongst poor South Africans, it is likely that any indirect deaths that result
from the pandemic would disproportionately occur amongst low-income communities. So, to
circumvent this, we must work to ensure that medical facilities do not become overwhelmed
by supporting high-risk populations currently excluded from DG coverage so that they can
204 Dahab et al., “COVID-19 Control in Low-Income Settings and Displaced Populations”; Samantha Artiga and
Elizabeth Hinton, “Beyond Health Care: The Role of Social Determinants in Promoting Health and Health
Equity,” The Henry J. Kaiser Family Foundation (blog), May 10, 2018, https://www.kff.org/disparities-
policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/. 205 Berk Özler, “What Can Low-Income Countries Do to Provide Relief for the Poor and the Vulnerable during
the COVID-19 Pandemic?,” accessed April 2, 2020, https://blogs.worldbank.org/impactevaluations/what-can-
low-income-countries-do-provide-relief-poor-and-vulnerable-during-covid.
91
properly adhere to CDC guidelines and supplement their households’ decreased income
during the lockdown.
World leaders across the globe understand the importance of protecting high-risk
persons from the health and economic consequences of the pandemic. In many countries,
policymakers are implementing social insurance measures that provide more, or more
flexible, paid sick leave to workers. Canada, for instance, is allowing employees with “no or
limited paid-leave benefits through their employers” to “apply for up to 15 weeks of
employment insurance if they cannot work for medical reasons such as cancer, a broken leg,
or in this case, being quarantined in a public-health threat.” Additionally, Ethiopia now
permits “government employees who are at higher risk of COVID-19 (elderly, pregnant
women, those with underlying conditions) to stay home while receiving their salaries.”206
These countries recognize the increased risk of severe illness that vulnerable populations are
facing and the consequent necessity to reduce their exposure to the virus (while
simultaneously maintaining their economic welfare) in order to curtail strain on medical
facilities and potentially lower rates of (direct and indirect) mortality.
Hence, I propose that the DG increases its number of beneficiaries in order to account,
at most, for the estimated 2.2 million untreated, immunocompromised poor people who are
not virally suppressed and who have been excluded from grant access because of
administrative flaws. Due to the existing biometric requirements necessary for enrolling new
beneficiaries into the social grant system, it seems unlikely that SASSA presently has the
ability to expand coverage. However, increased leniency in the DG eligibility assessment
process would tackle this issue.
206 Ugo Gentilini et al., “Social Protection and Jobs Responses to COVID-19: A Real-Time Review of Country
Measures,” n.d., 104.
92
Consider the social insurance measures implemented in Kosovo intended to support
its vulnerable populations. In this country, “all verification procedures for social assistance
(and pensions) benefits are suspended until further notice.” Admittedly, this response requires
beneficiaries to visit public offices for administrative purposes.207 However, this does not
have to be the case in South Africa. As aforementioned, South Africa plans to deploy 67
mobile testing units into low-income communities with large concentrations of high-risk
individuals and higher transmissibility potential due to large household sizes and poor
sanitation. Two nurses conduct the registration and testing that occur in these units. If a
SASSA officer were to join these medical professionals, they can use the patients’ medical
reports and identifying information to approve unsupported high-risk individuals for DG
coverage. Thus, SASSA can manage to expand DG coverage to the deserving,
immunocompromised poor by identifying high-risk residents during COVID-19 swabbing,
conducting a laxed Activity Limitation assessment on site (keeping in mind the social aspects
of one’s life that makes them unable to work, like the pandemic), and then registeristering
this vulnerable people for social protection.
Increased leniency in eligibility assessment is likely to cause inclusion errors.
However, I do believe that grants should be awarded to all those assessed and considered
high-risk in order to supplement their families' incomes and to help them protect their own
health during the pandemic. Additional household income could disincentivize high-risk
individuals’ household members from participating in informal work outside of the house.
Rates of informality are higher in lower-income countries, and already, South Africa’s social
protection system fails to offer support to working-aged, able-bodied, and unemployed
207 Gentilini et al., “Social Protection and Jobs Responses to COVID-19: A Real-Time Review of Country
Measures.”
93
persons.208 Without a safety net for those who are informally employed, high-risk individuals
might be living with people who cannot afford to sacrifice their only source of income for the
sake of social distancing, putting immunocompromised individuals at risk of exposure to
COVID-19. Increased household income by means of a cash transfer could encourage social
distancing practices, decreasing transmission of COVID-19, and consequently prevent
overload in South African medical facilities. Medical professionals conducting DG eligibility
assessments should do so generously after identifying high-risk residents through screenings.
SASSA officials can register eligible residents for temporary (6-month) DG receipt
virtually when they enter their communities. They can be given electronic smartcards for
identification and payments like other DG beneficiaries. Notably, SASSA services were
suspended for the duration of the national lockdown, meaning that no applications were
processed in local offices. While this decision was made in compliance with social distancing
rules to slow the spread of COVID-19 and likely benefited public health, high-risk
individuals excluded from grant receipt could not apply for DG coverage when they needed it
most. Processing applications mobily will allow medical professionals to adhere to social
distancing guidelines, just as they are while they screen and test residents for COVID-19, and
will grant high-risk persons the coverage they and their families need during this pandemic.
Political, Economic, and Administrative Feasibility:
I estimate the cost of this DG expansion to be approximately R4.1 billion per month
for the next six months (R24.6 billion in total), barring administrative costs. This is based on
calculations suggesting that the grant will extend coverage to 2.2 million beneficiaries, paid
R1,860 per month. During all instances of rounding, estimates were rounded up to leave
208 Berk Özler, “What Can Low-Income Countries Do to Provide Relief for the Poor and the Vulnerable during
the COVID-19 Pandemic?,” accessed April 2, 2020, https://blogs.worldbank.org/impactevaluations/what-can-
low-income-countries-do-provide-relief-poor-and-vulnerable-during-covid.
94
room for those with other chronic illnesses, such as hypertension and diabetes, even though
these tend to be concentrated amongst groups with higher socioeconomic statuses in South
Africa. Additionally, the estimates should be high because I did not account for the fact that
illnesses are also likely to be more prevalent amongst the elderly, who are only eligible for
the Old Age Grant. There are also likely to be instances of overlap between those with HIV
and TB due to the prevalence of comorbidities amongst low-income populations.
As indicated in my economic analysis of implementation of a CIG, 56% of the 7.7
million PLHIV are low-income (4,312,000).209 62% of these people are receiving treatment,
as 2018 data suggests (2,673,440), and 87% of these treated individuals are virally suppressed
(2,325,892.8). These individuals will not be extended grant coverage because the DG
considers them to be able-bodied. Taking 2,325,892.8 from 4,312,000 leaves us with
1,986,107 low-income PLHIV who are not virally suppressed or on treatment that need social
protection during the pandemic for the sake of their health and the South African health
system. Add to this the number of low-income individuals with active TB (calculated earlier:
153,173.8), we can expect DG expansion to need to reach 2,139,281 people, rounded up to
2.2 million beneficiaries paid R1,860 per month. An intervention costing R4.1 billion per
month is much less costly than the proposal for the CIG or some of President Ramaphosa’s
other proposed measures, and by nature of the intervention, extending coverage to particular
high-risk people also has worthwhile public health benefits.
However, in recent years, the DG has acquired the reputation of being a grant that
adds economic strain to the government. It is because of the assumption that working-aged
people without sufficient incomes have taken advantage of the grant and have “performed
disability” in order to receive it.210 Additionally, when the government wanted to extend
209 Ataguba, Akazili, and McIntyre, “Socioeconomic-Related Health Inequality in South Africa.” 210 Kelly, “(PDF) ‘We Want Another Doctor!’ Citizen Agency and Contested Notions of Disability in Social
Assistance Applications in South Africa.”
95
grant coverage in 2000, it implemented a measure intended to take into account both
biomedical and social understandings of an applicant’s ability to work, similarly to what I am
proposing (that assessments be more relaxed because of the social consequences of the
pandemic). Because of this increased leniency, “there was a rapid increase in temporary DGs
between 2001 and 2007.”211 The spike in cost to the government caused the eligibility
process to revert to its original state; a return to strictly medically-assessed applications due
to cost concerns. If policymakers fear that a lenient eligibility assessment process utilized
now would be too costly for the government to sustain, they are unlikely to support this
proposal
As of 2007, policymakers’ attempts to improve DG administration have occurred
within “a period of action or ‘rationalisation’ in which the state places new limits on access to
the grants, leading to decline in the number of social grant recipients.”212 Legislators fear
that, too often, able-bodied yet unemployed South Africans and the chronically ill have taken
advantage of the DG because of their exclusion from other forms of social protection. The
South African National Development Plan acknowledges the holes in South Africa’s safety
net and intends to offer protections to these excluded groups. Similarly, the Interministerial
Committee on Social Security and Retirement Reform plans to reform South African social
security by “consolidating and extending social insurance provisioning,” ultimately “moving
the risk of disablement from the state to individuals who are in the position to contribute to
public social insurance schemes.”213 However, little progress has been made toward
supporting the able-bodied unemployed, so this population continues to access social
protection any way they can. It is because of this heightened demand for DG coverage that
211 Kelly, Regulating Access to the Disability Grant in South Africa, 1990-2013. 212 Kelly, Regulating Access to the Disability Grant in South Africa, 1990-2013. 213 Kelly.
96
policymakers have focused their efforts on placing restrictions on grant access. Expansion of
the grant is politically unpopular.
Additionally, as is the case with most cash transfers, there is a common concern that
grant access causes dependency from beneficiaries and their families and that it
disincentivizes work. Again, this makes grant expansion seem unpopular. However, research
has shown that the “DG’s inclusion errors are relatively limited but exclusion errors are
substantial and serious.”214 Mitra cites an instance of policy reform in disability screening in
Gauteng from the early 2000s in which eligibility determination became much more lenient.
As a result of expanded coverage, there was no significant impact on working-aged
individuals’ decisions to participate in the labor force, as the expansion “seems to have
absorbed those who were already out of the broad labor force” due to South Africa’s high
unemployment rates.215 This finding challenges scholars who believe that cash transfers
disincentivize work. It, instead, exposes the fact that the DG is being used in place of a
poverty-alleviation measure that could be supporting the able-bodied unemployed. Kelly
eloquently concludes, “Without adequate protection to support everyone living in or at risk of
falling into poverty, the disability grant system has served a purpose for which it was not
originally intended.”216 Using studies like Mitra’s to refute the widely-held conviction that
grants cause dependency could make expanded grant coverage more feasible, politically.
Considering the relevancy of an international pandemic and the heightened risk it
presents to certain populations, politicians should be amenable to extending support to the
immunocompromised poor. This is because the sick and disabled are often considered to be
more “deserving” than other low-income groups, as well as the elderly and children.217
214 Mitra, “Disability Cash Transfers in the Context of Poverty and Unemployment.” 215 Mitra. 216 Kelly, Regulating Access to the Disability Grant in South Africa, 1990-2013. 217 Katz, The Undeserving Poor.
97
Additionally, protecting those at risk for severe illness is beneficial to public health,
generally, as it decreases the chances of overwhelming hospitals, which would result in high
mortality rates from COVID-19 (due to limited treatment technologies) and indirect deaths.
My proposal for increasing grant coverage can be carried out with relative
administrative ease. Already, SASSA distributes hundreds of thousands of temporary
disability grants, and the process for those newly-registered will be no different. One nurse
from the mobile testing units can lead the medical assessment while the other collects
medical history and identifying information, and the SASSA bureaucrat can be present to
approve eligibility. Additionally, the registration process is actually being made less complex.
The main focus, here, is to ensure coverage for individuals at high-risk of severe illness from
COVID-19. If the medical professionals can conclude, after the medical assessment and
review of a patient’s documents, that the township resident might be part of a high-risk
population and is currently unsupported, they should be deemed eligible for DG coverage.
If SASSA has the capacity to send bureaucrats into the field along with the testing
unit professionals, then this process is easily achieved. However, reports from officials
monitoring SASSA sites have suggested that provincial offices, at least, are understaffed.218
If SASSA cannot send officers into townships to approve eligibility for high-risk residents,
then the assessments from the mobile units’ medical officials will have to make their way
back to an office some alternative way to be processed there. Lack of administrative capacity
from SASSA’s end could make this proposal infeasible.
Shortcomings:
While research has shown that a DG beneficiary’s income is shared within
households, “conflicts may arise over how income is shared and may lead to the extortion,
218 “Black Sash - Black Sash.”
98
abuse and neglect of disabled people, particularly in cases of severe disablement.”219 The
extortion of a high-risk individual in the midst of a pandemic might result in the interruption
of their medical treatment, further exacerbating their risk for severe illness from COVID-19.
Already, reports have indicated that South African police forces intend to ramp up family
violence and protection units in anticipation of increased rates of domestic abuse within
households during the lockdown.220 Thus, there is a chance that extending grant access to
chronically ill individuals not currently receiving the grant, especially those whose family
members might consider them to be undeserving, will put them at risk of abuse.
The sharing of grant money might also suggest that new DG beneficiaries might not
choose to, or be able to, use the additional income to protect themselves from exposure to the
virus in the ways that I have mentioned. According to the Centre for Social Development in
Africa, “grant monies are mainly used for food (74.2 percent),” and only 17.1 percent are
used “to protect themselves against risk.”221 While I am hoping that high-risk individuals will
use their grant money to heed the CDC’s recommendations (purchasing medication in bulk,
acquiring technology to help them stay connected with doctors, etc.), there is no way to
guarantee that this is what will follow from this policy measure. SASSA could, instead,
oversee the provisioning of technologies or medications to high-risk individuals. However, in
times as unpredictable as those during a pandemic, I believe that it best suits low-income
individuals to have the capability to spend additional income in any way they consider
necessary.
Kelly posits that “if [the DG] is used for general household maintenance DG
recipients remain trapped in poverty and an unfair burden is placed on a category that the
219 Kelly, “The Influence of Disability-Related Cash Transfers on Family Practices in South Africa.” 220 Harrisberg, “S. Africans Fear Safety Divide as Coronavirus Panic Takes Hold.” 221 Patel et al., The Gender Dynamics and Impact of the Child Support Grant in Doornkop, Soweto.
99
state has explicitly defined as vulnerable.”222 Ideally, the DG will serve to empower high-risk
people and help them protect themselves from exposure to COVID-19, but it is possible that
their incomes will be so widely shared in their households that grant receipt has negligible
effect. A lack of support for the able-bodied unemployed is what turns DG payments into
poverty-alleviation funds.
Conclusion:
On March 24, 2020, President Cryril Ramaphosa stressed to South Africans that their
“fundamental task” was to contain the spread of COVID-19.223 The decree was informed by
evidence of mass transmission in other countries and by health professionals’ warnings that
the immunocompromised, such as South Africa’s millions of HIV-positive individuals, are at
high risk for developing complications from COVID-19 infection. In order to avoid
overwhelming medical facilities, the President implored South Africans to heed social
distancing protocols and practice good hygiene.
Thus, when I began developing my policy proposals, it was with the intent to protect
South Africans from the public health consequences of a pandemic. However, time has
proven that the pandemic in South Africa is likely to cause a greater economic crisis than a
humanitarian one (refer to the graph in the Introduction chapter). As evidenced by President
Ramaphosa’s April 21 decree to the South African people, the COVID-19-related
interventions decided upon by the government are, in large part, intended to help mitigate the
economic consequences of the pandemic. The “massive social relief and economic support
package of R500 billion” offers support to those who are low-income through the social grant
system and attempts to “address the extreme decline in supply and demand and protect
222 Kelly, Regulating Access to the Disability Grant in South Africa, 1990-2013. 223 “Statement by President Cyril Ramaphosa on Escalation of Measures to Combat the Covid-19 Epidemic,
Union Buildings, Tshwane | The Presidency.”
100
jobs.”224 Regarding the immunocompromised and the elderly, President Ramaphosa’s only
instruction was to remain at home while lockdown regulations begin to ease for others.
In light of the eventual lifting of lockdown restrictions, I believe that the South
African government should reconsider the degree of emphasis that their protections package
places on the economic impact of the pandemic. Reports have warned other nations that the
reopening of civil society can lead to resurgences of the outbreak.225 Considering South
Africa’s large immunocompromised population, I believe that my proposals, as well as others
intended to protect citizens from the public health consequences of a pandemic, can inform
additional policy interventions that can accompany the ones in Ramaphosa’s plan. Now that
South Africans will begin to reenter the community, those with underlying medical
conditions must take more precautions to limit themselves from viral exposure, and those
who are low-income need the means to do so. For these reasons, I believe that the issues
brought forth in this paper are still relevant.
Though, it is important to note that a large portion of my target population will likely
be able to access coverage from the new Covid-19 Social Relief of Distress grant. The grant
pays R350 a month for 6 months to those currently excluded from accessing any other grants,
which absorbs the immunocompromised who have been excluded from DG receipt, whether
it be because of their restored health and possible treatment dependency or due to the
arbitrary eligibility assessment process. The special SRD grant is more generous than my
proposals to expand the DG or to create a CIG in that it will cover a broader swath of the
population, yet less generous in that it would pay out only a fraction of what I suggest (R350
vs. R1,860). In the Conclusion chapter of this paper, my team and I discuss why we believe
R350 to be an insufficient allocation.
224 “STATEMENT BY PRESIDENT CYRIL RAMAPHOSA ON FURTHER ECONOMIC AND
SOCIAL MEASURES IN RESPONSE THE COVID-19 EPIDEMIC.” 225 McFall-Johnsen, “Countries in Asia Are Facing New Waves of Coronavirus Infections after Lockdowns Lift.
The Same Could Happen in the Rest of the World.”
101
Overall, my analysis suggests that, in principle, there is a compelling argument for
targeting the immunocompromised poor as a public health protection, but that it is not
feasible in practical terms. Extending coverage to all experiencing immunosuppression or
treatment dependency decreases the chances of overburdening health systems. The
immunocompromised poor are high-risk for developing complications from COVID-19
infection and are thus more likely to require hospitalization and use of medical technologies
than their healthier counterparts. They are also more likely to die. Protecting this population
would lower mortality rates in addition to relieving pressure on medical facilities.
It is important to note that, as research on the pandemic has come to light, some
scholars have presented hypotheses that some immunocompromised individuals who are able
to maintain treatment for their conditions are not high-risk. Avert explains that while those
“living with HIV not on treatment or virally suppressed may be at a greater risk,” people
“living with HIV and on effective antiretroviral treatment (ART) are currently not at an
increased risk of getting coronavirus, or developing severe symptoms.”226 Since South Africa
has a tax-funded ARV-rollout program in place to support its millions of PLHIV, the
government might assume that this population consequently needs no special protection.
However, it is the interruption of treatment, caused by the economic devastation that the
pandemic has and will cause for low-income communities, that could exacerbate the
humanitarian crisis in South Africa. If an immunocompromised person cannot pick up their
medication or is forced to prioritize other stressors in their life caused by the pandemic
(familial illness, sudden loss of income, etc.), their lack of treatment adherence puts them,
once again, at risk for severe illness. Additionally, my proposal for DG expansion hopes to
absorb this high-risk, untreated nor virally suppressed population who have been excluded
from grant access because of various administrative barriers.
226 “Coronavirus (COVID-19) and HIV.”
102
Finally, there is a notable difference between HIV and COVID-19. HIV appears to be
non-terminal for most people if they adhere to ARVs. Treatment without a DG, then, is an
option. However, COVID-19 has high fatality rates among specific populations. It is
particularly devastating within urban poor communities and black communities, as those
living in these places are more likely to have underlying medical conditions which would
therefore require additional coverage in order to adequately protect them from severe
illness.227 This evidence suggests that social distancing without a DG or another grant is not
an option in South Africa today. There is a real link between a grant and ability to social
distance, which is a protocol that has been proven to save lives. This parallels the way that
there was a very strong argument for tax-funded ARVs for people with HIV in order to keep
this population alive, as well.
All of this considered, extending social grants to the immunocompromised poor is not
feasible in practical terms. First, it cannot be done without inclusion errors. DG applicants
have been shown to “perform disability” in order to sway medical officers to allow them
grant access.228 In the case of more relaxed eligibility assessments, as I suggest here, it is
likely that some of the temporary DGs would end up in the hands of those who do not truly
need them. While this decreases political feasibility, the target population of this grant is so
miniscule compared to other suggested measures and the potential for public health
devastation so great that I believe that some inclusion error should be acceptable in the name
of averting further crises. However, if we are to be accepting of inclusion errors for the sake
of public health, it only makes more sense to create, instead, a grant that actually extends
coverage to all those who truly need it: people whose poverty is compounded by the
pandemic and national lockdown.
227 Vesoulis, “Coronavirus May Disproportionately Hurt the Poor—And That’s Bad for Everyone.” 228 Kelly, “(PDF) ‘We Want Another Doctor!’ Citizen Agency and Contested Notions of Disability in Social
Assistance Applications in South Africa.”
103
The conservative size of the target population also means that the implementation of
this grant would cost less than other measures. However, at least in the case of a CIG, which I
hope to become a permanent feature of the social protection system, the proposals could
exacerbate the economic strain that the grant system currently experiences (in normal
circumstances) in the future. Implementation of the CIG works best when paired with a tool
like the HAT to reform the DG. But the HAT necessitates Activity Limitation assessments
that require staffing that the DOH currently does not have the capacity to supply.
Administration of these grants would thus become more expensive.
Evidently, there are valid reasons why creation of a CIG or expansion of the DG in
times as unpredictable as these are not the most fruitful paths of reform to go down.
However, as the end of April draws near, so does the end of the stringent lockdown protocols
in South Africa. As certain communal activities are allowed to resume, the
immunocompromised poor, especially those living in densely packed urban areas, are
particularly vulnerable to suffering should there be a resurgence of COVID-19 infections. If
evidence of this calamity begins to take shape, I strongly urge policymakers to reconsider
proposals for extending social protection to immunocompromised South Africans. This
population is encouraged to take extra precautions while not given the means to do so.
Compared to the R50 billion that the President is already allocating to social relief
interventions, spending either R8.4 billion per month (for establishment of a CIG) or R4.1B
per month (for expanding DG coverage), to ensure protection for South Africa’s most
vulnerable individuals is a small price to pay. As the country continues to attempt to return to
normalcy, the immunocompromised will continue to have their well-being threatened by the
possibility of another outbreak of COVID-19, for which there is no cure.
104
It’s imperative that the government continues to stress the importance of sheltering
immunocompromised populations as lockdown restrictions are eased, at least. This is for the
sake of saving millions of lives and preventing the overburdening of health systems.
105
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107
prepares-it-for-virus-testing/.
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108
Conclusion
In the concluding portion of this report, we will summarize the pursuits and findings of the
three central chapters; explain the relevance of a Universal Basic Income in the context of
international responses to COVID-19; present a comparative visualization of the policies
outlined throughout the paper; and make specific commentary and recommendations in
response to President Ramaphosa’s recently announced plans for social grants reform.
Outlined Proposals and UBI
Over the course of writing this report, responses to COVID-19 both within South
Africa and around the world have changed significantly, as has information about the nature
of the virus and the potential time frame of lockdowns. These proposals were written in the
context of South Africa’s limited adaptation of social protection programs around early April,
taking particular consideration of which populations may prove most vulnerable to the health
and economic consequences COVID-19. While South African policy has shifted in the
interim, the proposals in this report provide a useful basis for analyzing President
Ramaphosa’s plan, identifying strengths and weaknesses and recommending appropriate
interventions and strategies as the crisis continues to unfold.
This report was not written to weigh proposals against one another, but to inform a
series of interventions which could collectively benefit vulnerable and overlapping swaths of
South Africa. Chapter 1 focused most broadly on the country’s very poor, facing potential
food shortages and an inability to adhere to COVID-19 health guidelines. Chapter 2 looked at
the country’s informally employed, many of whom are expected to lose income without
becoming eligible for unemployment insurance. Chapter 3 centered around the
immunocompromised poor, especially susceptible to COVID-19-related health
109
complications. Final proposals aim to account for effectiveness in benefiting the target
population, but also for costs, logistical and political feasibility.
Another possible policy intervention not evaluated in the three main chapters of this
report is Universal Basic Income (UBI). A global group of 500 academics and politicians
have argued that an extensive UBI is the most appropriate (though incomplete) response to
COVID-19 across the world.229 One article from the UK writes that a UBI “would not only
help the most precarious workers in the economy, allowing them to weather the storm
financially. It would also alleviate the strain on businesses resulting from salaried employees
being unable to work.” The article adds that a UBI “could help reduce the spread of the virus
if no one is forced to work for money while risking other people’s lives.”230 Lumkile Mondi,
a lecturer at the School of Economics and Business Science at the University of the
Witwatersrand, even suggested a four-month, R1000 per month UBI for South Africa’s
population of 58-million. Importantly, South Africa considered implementing a UBI in the
early 2000s to ameliorate poverty and unemployment, but rejected the proposal over
criticisms about providing aid to those with the capacity to work.231
Few countries have implemented a truly universal basic grant in response to the
pandemic. One example is Hong Kong, where permanent residents over the age of 18 will
receive HK $10,000, benefiting approximately 7 million people.232 An unadjusted UBI is
perhaps less feasible for the over 57 million people in South Africa, especially given South
229 “Letters: Why over 500 Academics Have Called for Universal Basic Income in the Fight against
Coronavirus,” The Independent, March 18, 2020, 500,
https://www.independent.co.uk/voices/letters/coronavirus-universal-basic-income-ubi-poverty-economy-
business-migrants-a9408846.html. 230 Ayako Ebata, Philip Mader, and Gerald Bloom, “Precarious and Informal Work Exacerbates Spread of
Coronavirus,” Institute of Development Studies, March 23, 2020, https://www.ids.ac.uk/opinions/precarious-
and-informal-work-exacerbates-spread-of-coronavirus/. 231 H. J. Dawson and E. Fouksman, “Labour, Laziness and Distribution: Work Imaginaries among the South
African Unemployed,” Africa: The Journal of the International African Institute 90, no. 2 (March 25, 2020):
229–51. 232 Ugo Gentilini et al., “Social Protection and Jobs Responses to COVID-19: A Real-Time Review of Country
Measures,” April 10, 2020.
110
Africa’s already strained fiscus. An example of an income-constrained universal grant has
been put in place in Singapore. Singaporeans aged 21 or above will receive a one-time
payment of $300, $600, or $900 from the Care and Support Grant depending on income.233
Singaporeans who benefit from the Workfare Income Supplement – a program to enhance the
salaries of low-income workers – will also receive a $3,000 cash grant. While social grants
were an important aspect of Singapore’s initial highly effective handling of COVID-19, the
income gradients employed in the Care and Support Grant would be more difficult to
implement in South Africa, where many workers are not registered and do not report
incomes. Singapore does not release official statistics on non-standard employment but is
thought to have the vast majority of workers protected by “regulatory oversight and
employment protection.”234 Potential UBI costs and limitations for South Africa are
considered along with other targeted proposals from this report.
Visualization
The following chart serves as a comparative visual representation of the policy
reforms outlined throughout this report. In order to provide relevant context beyond cost
projections, political feasibility and practical shortcomings are also summarized.
Proposal Target
Population
Estimated
Cost*
Political Feasibility** Shortcomings
Top Up
CSG
Very poor,
informally
employed
R6.7B -
R8.8B per
month
R20.1B -
R26.4B
over 3
High.
(+) CSG has been expanded in the
past
(+) With existing social grant
infrastructure, requires low
administrative involvement
(-) Assumes that CSG
acts as income and will
be distributed equally
among household
members
(-) Potentially disrupts
233 “Care And Support Package,” Singapore Budget 2020, n.d.,
https://www.singaporebudget.gov.sg/budget_2020/budget-measures/care-and-support-package. 234 “Regional Study on Informal Employment Statistics to Support Decent Work Promotion in ASEAN”
(Jakarta, Indonesia: ASEAN, 2019), https://asean.org/storage/2012/05/13-Regional-Study-on-Informal-
Employment-Statistics-to-Support-Decent-Wo....pdf.
111
months
R40B -
R52.8B
over 6
months
(-) Acknowledges the use of the CSG
as general household income
existing kinship
networks
Expand
SRD
Very poor R7.7B -
R27.4B per
month
R23.4B -
R82.2B
over 3
months
R46.8B -
R164.3B
over 6
months
Moderate.
(+) Time limitation ensures that aid
will expire when dire need has
subsided
(+) Distribution as food parcels and
vouchers ensures that cash isn’t spent
in ways that some might deem
irresponsible
(-) Bureaucratic application process
will require significant staffing
increases
(-) Brevity of
disbursement period may
leave recipients abruptly
unsupported
(-) Geospatial
particularities might
restrict recipients’ food
options depending on
where they live
(-) Local discretion in
grant approval may
result in exclusion errors
Expand
UIF
Informally
employed
(via the very
poor)
R5.3B -
R22.3B per
month
R15.9B -
R66.9B
over 3
months
R31.8B -
R133.8B
over 6
months
Moderate.
(+) In principle, targets the informally
employed ‘deserving poor’ and
promotes economic stability
(+) The UIF holds significant surplus
funds which could be reallocated
(-) In practice, reaches all very poor
working-age adults
(-) Many working-age
men do not feel that they
should receive social
grants
(-) Benefits those who
were not involved in
informal employment
Introduce
Universal
Basic
Income
All R57.8B per
month
(one-time
payment)
R231.2B
over 4
months
Low.
(+) Supplants the need for other
reforms; benefits all vulnerable
populations
(-) South Africa rejected a UBI
proposal in the early 2000s due to a
lack of political support235
(-) Distributionally challenging for
those lacking bank accounts, tax
returns, official registration
(-) Benefits the wealthy and
‘undeserving’ poor
(-) Extremely costly,
benefiting even the high-
income
Introduce
Chronic
Illness
Grant
Immuno-
compromised
poor
R8.4B per
month
R25.2B
over 3
Low.
(+) Protects vulnerable population
from severe illness from COVID-19
(+) Reserves the DG for PWDs
(-) CIG payments are
likely to be shared within
the household, as is the
case with DG payments,
and this could lead to
235 Dawson and Fouksman, “Labour, Laziness and Distribution.”
112
months
R50.4B
over 6
months
(+) Provides stable support for the
immunocompromised poor who
struggle to find employment within a
discriminatory workforce
(+) Reduces incentive for
immunocompromised poor to trade
off health/treatment for grant
eligibility
(+) Can be transformed in the future
(work programs, etc.)
(-) Necessitates creating a new grant
for a population that politicians are
barring from grant (DG) access
(-) Dependency discourse
(-) Implies that low-income people
with chronic illnesses, regardless of
how disabling, are more deserving
than low-income people without
chronic illness
extortion or abuse of the
CIG recipient.
(-) There is no way to
guarantee that CIG
payments will be used to
help beneficiaries follow
CDC’s recommendations
for high-risk populations
(-) Limited SASSA and
DOH capacity
Expand
DG
Immuno-
compromised
poor
R4.1B per
month
R12.3B
over 3
months
R24.6B
over 6
months
Low.
(+) Protects vulnerable population
from severe illness from COVID-19
(+) No new grant transformation or
creation, administratively simple
(+) Relaxed eligibility assessment
process
(-) The number of grant beneficiaries
has been declining as the gov’t
attempts to limit access for
chronically ill populations who may
be able to work but are taking
advantage of the grant
(-) Dependency discourse
(-) The sharing of DG
payments within
households can lead to
extortion, abuse, and
neglect
(-) There is no way to
guarantee that income
will be used by
beneficiaries to follow
CDC recommendations
for high-risk populations
*Figures listed in this table exclude administrative costs.
**Judgements of political feasibility rely on subjective projections.
Our judgement of the political feasibility of reforms is informed by the scope of their
coverage, their cost, and the extent to which a framework is already in place for their execution;
considered together, these factors indicate the efficiency of investment in a given intervention.
Of course, political feasibility looks very different during a pandemic than under normal
113
circumstances. Social protection programs have shifted in scope all over the world in response
to the pandemic; new cash transfer programs have been introduced in 78 countries.236
Nonetheless, many of the same considerations about programmatic reach and affordability
have played a role in South Africa’s COVID-19-inspired reforms.
We believe that the most politically feasible reform is CSG expansion, which would
support many of the very poor (including, potentially, those who are eligible and have not
signed up but would do so during a lockdown). Moderately politically feasible reforms include
SRD and UIF expansion, both of which could provide significant aid to populations that are
generally regarded as deserving of government support during a pandemic. The introduction
of new programs (such as UBI or CIG), as well as the expansion of DG (which supports a very
narrow population), are the least politically feasible. Given that the president has already
introduced a set of reforms to South Africa’s social protection scheme, we will use the above
considerations as a framework for analyzing his plan.
Point-by-Point Analysis of President Ramaphosa’s Emergency Plan
On April 21st, President Ramaphosa announced that the state would be allocating
R500 billion toward combating the virus, including R130 billion of reprioritized funds
already in the state budget, money raised from local sources, and donations from international
organizations like the World Bank and the International Monetary Fund.
Of this R500 billion, 10% — or R50 billion — will be put toward beefing up old
grants and creating new programs for those who are not covered under the current system.
The specific changes to social protection programs are outlined below in bold, each followed
by a brief analysis of social, political, and economic ramifications.
236 Gentilini, “6th Edition of Living Paper on Global Social Protection Responses!”
114
● A phased topping-up of the CSG, which currently awards R445 per month, per
child. This amount changes yearly, but in response to the pandemic, the
government has opted to temporarily increase the grant payment by R300 in May
(to R745 total) and by R500 from June to October (to R945 total).237
Given the vast network of needy individuals reached by the CSG, this proposal seems
justified. Increasing the CSG to R745 will place even those recipients who have no other
income above the FPL; raising it to R945 will place them above the LBPL, meaning that they
should face few financial barriers in accessing essential goods during the lockdown.
At the same time, the government should be wary of this policy’s potential to
undermine its general messaging that the CSG is intended to be used primarily on children —
which could have political ramifications down the line. Community leaders should also stay
vigilant in the case that the CSG top-up leads to intracommunal (or intrahousehold) conflict.
● A flat topping-up of other social grants, including the OAP and the DG. These will
be increased by R250 per month between from May to October.
As stressed in Chapter 3, certain populations have an increased risk of experiencing
severe illness from COVID-19 than others. The most vulnerable are the elderly and those
with underlying medical conditions, and the CDC recommends that these groups take
additional precautions in order to protect themselves from viral exposure. Topping up the
OAP and the DG will better enable the elderly and the immunocompromised to adhere to
social distancing guidelines, establish virtual connections to doctors or caretakers, and
maintain their health (via medication and sufficient food consumption).
237 Maeko and Mathe, “Covid-19 Grant Top-up Is for Caregivers, Not Children.”
115
However, as is the case with the CSG, increasing the payments made to older and
disabled persons could lead to intrahousehold conflict. Grant beneficiaries could face
exploitation, abuse, or neglect at home because of their additional income – so social service
agencies should be prepared to respond to and mitigate these instances.
● The genesis of a new COVID-19 SRD, which will award R350 per month for six
months to people who are unemployed and not receiving UIF benefits or any other
social grant support.
R350 per month would constitute the lowest standardized payment of any current
social protection program offered by the South African government. This payment falls short
of the FPL, meaning that even by necessarily conservative government estimates, it is not
enough to support a person’s basic nutritional needs — especially during a pandemic, when
normal food supply chains have been disrupted. In order for this SRD grant to represent a
meaningful intervention for the most vulnerable in South Africa (namely, those without any
income or alternative grant support), it should award at least R561 per month.
● A mass food parcel distribution, organized through partnerships between the
Department of Social Development, NGOs, and community-based organizations.
Ramaphosa has stated that this arrangement will manifest in the widespread
distribution of 250,000 food parcels in the two weeks after the announcement.
As a general matter, food parcels support general nutrition and eliminate the need for
long-distance travel for recipients to access their benefits. As such, this measure is a good
step toward ensuring that food scarcity does not lead to unnecessary deaths.
116
Food parcel distribution on a large enough scale could, in theory, patch up the
omission noted in the previous analysis by providing for the nutritional needs of South
Africans without incomes or grant support beyond R350. But since Ramaphosa has
announced the distribution of only 250,000 food parcels — and there are undoubtedly tens of
millions of people facing imminent hunger across the country — this measure simply does
not go far enough. Furthermore, food parcels cannot be delivered with enough regularity to
supplant the normal food supply for an entire household, especially considering the potential
for accountability issues on the ground that hinder the direct receipt of the parcels. As
recommended in Chapter 1, the government should work closely with local and regional
feeding schemes across South Africa to provide for the nutritional needs of vulnerable
populations.
● The introduction of a “technology-based solution” to provide food vouchers and
cash transfers. This arrangement is on the shoulders of SASSA, and little more
information is available at the time of publication.
Regardless of the details of this intervention, issues of geographical variability will
surely play a role in the effectiveness of both food vouchers (which are only accepted at
certain food dispensaries) and cash transfers (which require beneficiaries to travel to SASSA
checkpoints).
Final Evaluation: On the whole, Ramaphosa’s plan promises a number of meaningful
interventions that account for specifically vulnerable populations and the constraints of the
lockdown. However, we remain concerned about the adequacy of the money set aside for the
117
programs and the details of each measure’s implementation — a crucial factor that defines
whether or not the needy are actually able to benefit from government support.
Final Summary
President Ramaphosa’s COVID-19 response plan makes significant progress towards
helping those populations most vulnerable to the health and economic consequences of
COVID-19. A topping up of the CSG is a popular and administratively simple innovation,
benefiting many of South Africa’s poorest households and supplementing support for
children without schooling. Similarly, a food parcel system takes advantage of local
partnerships and is a politically palatable way of distributing aid to vulnerable children.
Importantly, the CSG is not expected to fully benefit non-recipient household members
including the informally employed, as this group will become eligible for the COVID-19
SRD. Considering that the emergency SRD grant will serve as quasi-unemployment
insurance for the informally employed and as the only grant available to some living in
extreme poverty, we believe that the value of R350 per month is insufficient to replace
incomes or cover the costs of basic necessities. In addition, it is still unclear how the South
African government will go about approving the COVID-19 SRD grant for those not
currently benefiting from social grants. Registration should be available via simplified online
forms, phone, and widespread in-person checkpoints to ensure that the grant reaches the most
vulnerable populations as quickly as possible. Finally, topping up the OAG and DG will
provide a financial cushion to those populations most at-risk for health complications relating
to COVID-19.
It is notable that the ANC is choosing to extend social protection to a historically
unsupported population: unemployed, working-age adults who do not have ties to formal
employment. In the past, a fear of “dependency culture,” which holds that social assistance
118
disincentivizes jobless populations from searching for work opportunities, has discouraged
policymakers from creating a grant for the unemployed in South Africa. However, many
countries are scaling up the size of their social protection systems in response to the COVID-
19 pandemic. Offering benefits for the unemployed is “the most frequently adopted
measure” in terms of social insurance, seen in nations like Russia, Romania, and the
Philippines.238 The implementation of this measure is made more feasible due to the looming
economic devastation that the pandemic has the potential to cause. Historically, cash transfer
programs have had the benefit of supporting those who have lost jobs or other means of
livelihood due to natural disasters or humanitarian crises and keeping the economy going by
giving citizens the means to purchase essentials. It’s no surprise that these trying times have
motivated the ANC to establish a COVID-19 SRD for its unemployed, working-age
population.
President Ramaphosa’s stimulus plan incorporates a number of the proposals explored
over the course of this report and creates a system of support for many of South Africa’s most
vulnerable residents. An alternative might be to create a basic income grant without
exclusions, but this faces administrative challenges similar to those of the COVID-19 SRD.
More resources should be invested in accessing and supporting those not currently benefiting
from the social safety net, but South Africa has taken an important first step.
238 Ugo Gentilini et al., “Social Protection and Jobs Responses to COVID-19: A Real-Time Review of Country
Measures,” n.d., 104.
119
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household reduce pesticide use? CSSR Working Paper No. 445.
Fainman, M. & Conradie, B. 2019. Wild-harvesting fynbos flowers: still a viable
business? CSSR Working Paper No. 444.
Hlungwani, P.M., Masuku, S. & Magidi, M. 2019. Mainstreaming of policies and
institutions towards engendering a pro-youth, consensual and progressive
empowerment policy in rural Zimbabwe. CSSR Working Paper No. 443.
Conradie, B. & Theron, S. 2019. Grazing indices for the Central Karoo.
CSSR Working Paper No. 442.
Oberth, G., Baptiste, S., Jallow, W., Manouan, A., Garcia, P., Traore, A.M.,
Murara, J & Boka, R. 2019. Understanding gaps in the HIV treatment cascade in
eleven West African countries: Findings from a regional community treatment
observatory. CSSR Working Paper No. 441.
Macheka, T. & Masuku, S. 2019. Youth participation structures in Zimbabwe: A
lens into the experiences of rural youth within WADCOs and VIDCOs.
CSSR Working Paper No. 440.
The Centre for Social Science Research
The CSSR is an umbrella organisation comprising five research units:
The AIDS and Society Research Unit (ASRU) supports innovative research into
the social dimensions of AIDS in South Africa. Special emphasis is placed on
exploring the interface between qualitative and quantitative research. Focus
areas include: AIDS policy in South Africa, AIDS-stigma, sexual relationships in
the age of AIDS, the social and economic factors influencing disclosure (of HIV-
status to others), the interface between traditional medicine and biomedicine,
the international treatment rollout, global health citizenship, and the impact of
providing antiretroviral treatment on individuals and households.
The Safety and Violence Initiative (SaVI) facilitates debate, research and
interventions across the university with a focus on understanding and
responding to violence and promoting safety. The initiative aims to establish
research collaborations that will contribute to promoting safety, reducing
violence and to raising awareness about these issues within South Africa and
other African countries. As university-based research collaboration a key feature
of SaVI’s role will be to develop theory and to translate this into practice.
The Families and Societies Research Unit (FaSRU) examines households, families
and kinship from an inter-disciplinary perspective. The ‘family’ in South and
Southern Africa is an institution undergoing rapid change, with implications for
the distribution of income and access to livelihoods, care-giving, child-raising and
health, intimacy and well-being, and social and political attitudes and behaviour.
The unit promotes research that links economic and social aspects of families
and households and employs mixed methods combining qualitative and
quantitative research.
The Sustainable Societies Unit’s (SSU) mission is to explore the social and
institutional dimensions of economic development and the interaction between
human society and the natural world. Focus areas include: winners and losers in
South African economic growth and the interplay between ecological and
economic concerns. The SSU was previously known as the Social Surveys Unit.
The UKRI GCRF Accelerating Achievement for Africa’s Adolescents (Accelerate)
Hub generates evidence on which development accelerators – alone and in
synergy with each other – can support adolescents in Africa to reach multiple
Sustainable Development Goals (SDGs). The Accelerate Hub is a partnership
between governments, international agencies, NGOs, donors, adolescents and
academics in Africa, Europe and North America.
